X 

LIBRARY 

I   uNivwsmr 
VCAUTORMIA 

BIOLOGY  LIBRARY 


THE 


HUMAN   BRAIN: 


ITS 


STRUCTURE,  PHYSIOLOGY  AND  DISEASES. 


WITH  A 


DESCRIPTION  OF  THE  TYPICAL  FORMS  OF  BRAIN 
IN  THE  ANIMAL  KINGDOM. 

'•  •  r  A*;V 

t 

BY  SAMUEL  SOLLY,  F.E.S., 

SENIOR  ASSISTANT-SURGEON  TO  ST.  THOMAS'S  HOSPITAL,  AND  LECTURER  ON  CLINICAL  SURGERY, 

ETC.  ETC. 


FROM  THE  SECOND  LONDON  EDITION. 


V7ITH  ONE. HUNDRED  AND  EIGHTEEN  WOOD-ENGRAVINGS. 


PHILADELPHIA: 

LEA     AND     BLANCHARD. 

1848. 


BIOLOGY  LIBRARY 


PHILADELPHIA  ! 
T.  K.  AND  F.  G.  COLLINS,  PRINTERS. 


TO 

BENJAMIN   TRAVEBS,  ESQ.,   F.E.S., 

PRESIDENT  OF  THE  ROYAL  COLLEGE  OF  SURGEONS  OF  ENGLAND, 

IN    REMEMBRANCE    OF    MANY    KINDNESSES, 

AND  AS  A  TRIBUTE  OF  RESPECT 
FOR    HIS    DISTINGUISHED    TALENTS, 

THIS    WORK 

IS  INSCRIBED  BY  HIS  OBLIGED  PUPIL, 
AND  SINCERE  FRIEND, 

SAMUEL  SOLLY. 


059 


PREFACE. 


IN  the  first  edition  of  this  work,  in  1836, 1  remarked  that  the  structure 
and  functions  of  the  human  brain  are  objects  of  comparatively  slight  in- 
terest to  the  medical  student.  I  fear  that  this  is  still  too  much  the  case 
in  1847. 

According  to  the  plan  generally  pursued  in  describing  the  brain,  in 
systematic  works  of  anatomy,  the  information  conveyed  amounts  to  little 
more  than  a  vain  catalogue  of  names  applied  to  parts,  without  reference 
to  their  structure,  their  functions,  or  even  their  analogies  in  the  nervous 
system  of  the  lower  orders  of  animals.  Such  a  barren  prospect  as  a  list 
of  names  holds  out  but  little  to  attract  the  most  zealous  among  students, 
while  the  dryness  of  unconnected  detail,  and  the  obstacles  to  clear  con- 
ceptions engendered  by  the  absence  of  everything  like  arrangement,  al- 
most certainly  deter  him  from  attempting  to  learn  more  than  is  required 
to  prepare  him  for  examination  for  the  diploma.  It  is  unfortunate,  in- 
deed, that  candidates  for  this  honorable  certificate  are  still  very  generally 
required  to  describe  the  appearances  presented  by  the  brain  dissected, 
or  rather  destroyed,  by  the  old  method  of  slicing ;  a  method  most  un- 
philosophical  in  its  conception,  and  totally  inadequate  to  impart  any 
real  information  in  regard  to  the  structure  of  the  organ.  And  I  do  not 
hesitate  to  affirm  that  this  mode  of  examination  has  contributed  essen- 
tially to  retard  the  diffusion  of  sound  knowledge  in  regard  to  the  anatomy 
and  physiology  of  the  most  important  system  in  the  body. 

It  is  sad  to  reflect  that  medical  students,  on  whom  the  duty  devolves 
of  tracing  the  relations  which  exist  between  the  structure  of  organs  and 
their  functional  manifestations,  with  a  view  to  the  successful  treatment 
of  disease,  should  thus  neglect  the  most  important  part  of  the  whole 


vi  PREFACE. 

organism.  No  labor  should  be  thought  too  great  which  can  assist- us  in 
understanding  the  nature  of  that  instrument  which  the  mind  employs  in 
its  communications  with  this  world.  Every  day  shows  us  that  conscious- 
ness and  volition  maybe  disturbed  by  the  slightest  accident  to  the  head, 
and  that  disease  seldom  invades  the  brain  without  dethroning  the  mental 
powers. 

When  I  published  the  first  edition  of  this  work,  I  was  not  aware  that 
so  high  an  authority  as  Dr.  Craigie  had  exposed,  in  the  following  forcible 
language,  the  evils  I  then,  and  have  since,  deplored.  I  gladly  avail  my- 
self of  his  authority  to  assist  in  subduing  this  evil : — 

"  To  the  mind,  however,  which  is  unfettered  by  prejudices  in  favor 
of  ancient  opinions,  it  appears  singular  that  the  enlightened  physiologists 
of  the  eighteenth  century  should  talk  of  the  medullary  and  cortical  mat- 
ter of  an  organ  in  which  nothing  like  marrow  or  bark  can  be  seen;  and 
it  is  more  extraordinary  still,  that  the  accurate  distinctions  which  ana- 
tomy has  introduced  since  the  commencement  of  the  nineteenth  century, 
have  not  demonstrated  the  evil  of  retaining  terms  which  are  improper, 
as  mere  nominal  distinctions;  but  which  are  doubly  erroneous  as  the 
relics  of  an  unfounded  and  exploded  theory.  Is  the  error  of  likening 
the  brain  to  marrow,  obviated  by  shrouding  it  under  the  learned  deno- 
mination of  medulla  and  medullary?  Or  is  the  absurdity  of  supposing 
the  gray  matter  of  the  convoluted  surface,  a  bark,  or  envelope  to  the 
white  pith,  diminished  in  the  slightest  degree  by  calling  that  gray  mat- 
ter cortical?  The  common  sense  of  the  present  day  will  not  hesitate  to 
answer  these  questions  in  the  negative. 

"  Should  it  be  said  by  the  ambiguists,  that  now,  when  the  absurdity 
of  these  names  is  known,  it  can  do  no  harm  to  retain  them  as  mere 
names,  we  answer,  it  may  do  no  harm ;  but  as  it  can  communicate  no 
information  and  explain  no  difficulties,  it  is,  at  least,  a  superfluous  labor 
to  augment  the  confusion  of  a  department  of  anatomy  not  very  easy,  by 
useless  and  antiquated  names,  which  live  only  to  proclaim  their  absurd- 
ity, and  the  impropriety  of  finding  them  there.  Knowledge,  in  the  pre- 
sent day,  to  be  worth  the  labor  of  acquisition,  ought  to  be  accurate ;  the 
books  which  are  to  be,  the  means  of  conveying  this  knowledge  ought  to 
contain  no  superfluous  or  erroneous  information." 

Foville,  who  has  devoted  so  much  attention  to  the  structure  of  the 


PREFACE.  vii 

brain,  though  he  has  paid  too  little  attention  to  the  labor  of  others,  thus 
expresses  himself  in  regard  to  the  difficulties  which  attend  its  study  :* — 
"  If  we  confine  ourselves  to  the  examination  of  its  exterior,  we  know  no 
more  of  its  organization  than  we  could  know  of  the  human  body  if  we 
merely  looked  at  the  surface  of  the  carcass:  even  sections  of  the  brain 
teach  little  more  than  sections  of  the  body  would." 

Foville  gives  to  Gall  the  credit  of  teaching  us  how  to  separate  the 
fibres  of  the  brain  without  cutting  them. 

1  have  been  much  disappointed  with  Foville's  work.  The  anatomical 
descriptions  are  most  tediously  minute,  without  any  reference  to  physio- 
logical inferences.  For  instance,  the  shape  and  outline  of  a  part  will 
be  given  most  accurately,  but  not  one  word  regarding  the  course  and 
direction  and  termination  of  its  component  fibres;  and  still  less  is  any 
attempt  made  to  classify  the  component  parts  of  the  brain  under  the 
heads  of  ganglia,  commissures  and  nerves.  So  that,  after  having  waded 
through  a  long  description,  the  pons-Varolii,  for  instance,  we  are  left  quite 
in  the  dark  as  to  whether  this  part  is  a  commissure  or  a  ganglion,  or  both 
combined. 

Is  it  not  strange  that  any  man  who  has  devoted  his  attention  to  the 
anatomy  of  the  brain,  as  Foville  has  done,  should  gravely  assert  that  we 
might  as  well  describe  the  optic  nerve  as  an  optic  bulb,  as  the  olfactory? 
No  student  who  has  traced  the  varied  forms  and  position  of  the  olfactory 
ganglion  in  the  various  classes  of  animals  up  to  man,  will  make  such  a 
mistake.  His  words  are,  p.  508  :  "  And  if  we  ought,  in  speaking  of  the 
word  olfactory  lobe,  to  separate  its  description  from  that  of  the  nervous 
cords,  we  ought  with  equal  reason  to  separate  the  optic  nerve,  and  pre- 
sent it  also  as  a  particular  lobe." 

Cuvier,  in  the  report  which  he  made  to  the  Academic  Royale  des 
Sciences  de  Paris,  upon  M.  Serres'  work,  "  De  1'Anatomie  Comparee  du 
Cerveau,"  remarked  very  forcibly  on  the  inconvenience  of  dissecting  the 
brain  from  above  downwards  in  the  manner  generally  pursued,  and  he 
showed  that,  in  consequence  of  comparative  anatomists  adopting  this 

mode  of  dissection,  their  researches  into  the  constitution  of  the  nervous 

* 

*  Traite  Complet  de  1'Anatomie,  de  la  Physiologic  et  de  la  Pathologic  du  Systeme  Ner- 
veau  Cerebro-spinal,  par  M.  Foville,  p.  41. 


PREFACE. 

system  of  the  lower  orders  were  productive  of  very  imperfect  results,  in- 
asmuch as  the  chain  of  resemblance  between  the  lower  and  the  higher 
orders  of  animals  was  soon  lost  sight  of;  whilst  M.  Serres,  by  com- 
mencing with  the  dissection  of  the  spinal  cord,  and  tracing  it  upwards, 
was  enabled  to  throw  great  light  on  this  interesting  branch  of  physiology, 
and  to  prove  that  there  is  a  regular  gradation  in  these  parts,  that  the 
chain  is  perfect,  and  that  such  differences  as  do  occur  simply  consist  in 
the  abstraction  of  parts,  and  the  loss  of  those  powers  which  have  been 
proved  to  be  dependent  on  them. 

With  regard  to  the  nomenclature  which  I  adopted  in  the  first  edition, 
I  shall  continue  to  adhere  to  it  in  most  instances,  as  I  believe  it  to  be 
simple  and  correct.  I  still  think  it  is  an  error  not  to  distinguish  the 
ganglionic  portion  of  the  hemispheres  from  the  rest  of  the  mass,  as  the 
hemispherical  ganglion,  but  I  would  willingly  have  adopted  a  different 
title  if  a  better  one  had  been  proposed. 

I  have  endeavored,  without  presuming  to  arrogate  to  myself  the  credit 
of  discovering  any  new  system,  to  lay  down  a  plan  for  the  study  of  the 
anatomy  of  the  cerebro-spinal  axis,  founded  upon  the  rational  basis  of 
investigating  its  structure  in  man  by  the  light  of  comparative  anatomy. 

The  only  philosophical  method  of  simplifying  and  giving  a  character 
of  general  interest  to  the  anatomy  of  the  human  brain,  is  by  commenc- 
ing with  the  structure  and  functions  of  a  nervous  system  in  the  lowest 
and  simplest  forms  of  animal  existence,  rising  by  degrees  to  the  highest, 
carefully  observing  each  addition  of  parts,  and  the  relationship  borne  by 
these  to  an  addition  of  function.  By  pursuing  this  course  we  shall  be 
rewarded  by  finding  that  the  encephalon,  this  apparently  most  compli- 
cated organ  in  the  human  being,  is  but  a  gradual  development  from  an 
extremely  simple  fundamental  type  on  one  uniform  and  harmonious  plan, 
and  that  the  seeming  complexity  of  the  cerebro-spinal  axis  in  man  really 
arises  from  the  great  concentration,  as  opposed  to  the  extreme  diffusion, 
of  its  component  parts  in  the  lower  order  of  animals ;  for  in  no  particu- 
lar are  the  higher  orders  more  strikingly  distinguished  from  the  lower 
than  in  the  concentration  of  function  within  circumscribed  spaces.  In 
following  out  the  plan  I  have  adopted  in  this  work,  I  shall  strive  to 
avoid,  on  the  one  hand,  falling  into  the  error  of  attempting  too  minute  a 
detail  of  all  the  various  discoveries  which  have  been  made,  and  giving 


PREFACE.  ix 

an  account  of  all  the  various  opinions  which  have  been  broached ;  and, 
on  the  other,  of  basing  ray  descriptions  or  confining  my  views  to  the 
circle  of  ray  own  individual  researches  and  speculations.  My  constant 
object  will  be  to  clear  the  path  of  all  unnecessary  incumbrances ;  and, 
carefully  arranging  whatever  is  known  upon  the  anatomy  and  physiology 
of  the  human  brain,  to  keep  in  view  the  principle  which  Herschel  has 
so  concisely  stated,  that  "  Science  is  the  knowledge  of  many,  orderly 
and  methodically  arranged  and  digested,  so  as  to  be  attainable  by  one." 
Every  honest  and  erudite  anatomist  must  acknowledge  that  we  are 
indebted  mainly  to  Gall  and  Spurzheim  for  the  improvements  which 
have  been  made  in  our  mode  of  studying  the  brain.  For  my  own  part, 
I  most  cheerfully  acknowledge,  that  the  interest  which  I  derived  from 
the  lectures  of  Dr.  Spurzheim  at  St.  Thomas's  Hospital,  about  the  years 
1822  and  1823,  has  been  the  inciting  cause  of  all  the  labor  which  for 
above  twenty  years  I  have  at  intervals  devoted  to  this  subject.  I  believe 
that  to  Mr.  Green,  in  his  Dissector's  Manual,  is  due  the  honor  of  having 
first  given  to  the  English  student  an  abstract  of  Gall  and  Spurzheim's 
method  of  dissecting  the  brain.  Mr.  South,  in  his  edition,  enlarged  it 
considerably.  Believing  that,  in  the  first  edition  of  this  work,  I  had 
unintentionally  neglected  to  do  Gall  and  Spurzheim  full  justice,  I  got  my 
friend  Mr.  Streeter,  of  Harpur-street,  who  is  well  acquainted  with  this 
subject,  to  give  me  a  short  historical  account  of  the  order  in  which  their 
labors  appeared  before  the  world. 

20,  Harpur  street,  April  1847. 

MY  DEAR  SIR, — As  you  manifested,  in  the  Preface  to  the  first  edition  of  your  work 
on  the  Anatomy  of  the  Brain,  what  Gall,  in  one  of  the  latest  of  his  written  paragraphs, 
termed  "une  tendance  singuliere  que  manifestent  beaucoup  de  personnes,  d'attribuer 
notres  decouvertes  &  d'autres,  par  exemple  a  Reil,'7  &c.,  I  venture  to  direct  your  at- 
tention to  this  error,  into  which  you  have  fallen,  in  common  with  most  of  the  English 
writers  on  the  anatomy  and  physiology  of  this  most  curious  and  difficult  paft  of  the 
human  frame.  I  am  the  more  induced  to  do  so,  because  Dr.  Spurzheim  himself 
directed  my  attention  to  this  error  when  Mr.  Herbert  Mayo  was  engaged  in  his  courses 
of  Lectures  on  the  Nervous  System,  at  the  Royal  College  of  Surgeons,  nearly  twenty 
years  ago,  and  fell  into  the  same  mistake.  What  Gall  has  written  in  its  refutation, 
may  be  found  in  the  8vo.  edition  of  his  work  "  Sur  les  Fonctions  du  Cerveau,"  vol. 
vi.  p.  490.  What  Spurzheim,  in  a  pamphlet,  entitled  "  Examination  of  the  Objections 
made  in  Britain  against  the  Doctrines  of  Gall  and  Spurzheim,"  Edinburgh,  1817,  p. 
50-54;  in  the  Preface  to  his  "Anatomy  of  the  Brain,"  1826;  and  in  his  reprint  of 
Chenevix's  article  on  Phrenology,  from  the  Foreign  Quarterly  Review,  1830,  Ap- 
pendix. I  would,  however,  direct  your  attention  to  the  earliest  notices  of  the  dis- 


X  PREFACE. 

coveries  and  proceedings  of  these  illustrious  men  in  the  English  medical  periodi- 
cals— publications  which,  as  they  were  not  so  numerous  as  in  our  day,  may  be  fairly 
imagined  not  to  have  been  entirely  overlooked  by  the  co-existing  generation  of  men. 

The  earliest  notice  that  I  am  aware  of,  that  appeared  in  this  country,  was  that  in 
the  Medical  and  Physical  Journal,  for  1800  (vol.  iv.  p.  50).  It  refers,  however,  ex- 
clusively to  craniological  ideas : — 

"  Mr.  F.  J.  Gall,  at  Vienna,  has  finished  a  most  elaborate  work  on  the  Exercise  of 
the  Brain,  and  on  the  possibility  of  recognizing  the  several  Faculties  and  Propensities 
from  the  Construction  and  Form  of  the  Head  and  Skull.  Mr.  Geisweiler,  of  Parlia- 
ment-street, has  in  his  possession  a  part  of  the  manuscript  and  several  drawings,  fin- 
ished in  the  most  curious  and  elegant  style,  deserving  the  attention  of  the  curious. 
The  author  intends  to  publish  the  work  at  the  same  time,  both  in  England  and  Ger- 
many." 

This,  you  will  observe,  is  before  Dr.  Spurzheim  was  associated  with  him.  The 
next  medical  notice  appears  in  the  October  number  of  that  Journal  for  1805  (vol.  xiv. 
p.  327).  The  contributor,  Dr.  Arneman,  one  of  their  editors,  speaks  of  Dr.  Gall  as 
one  "  that  may  justly  be  ranked  amongst  the  most  extraordinary  men  of  the  present 
age."  He  states  that  their  Prussian  Majesties,  the  physicians  of  the  court,  all  the 
medical  professors,  and  among  them  the  Nestor  of  the  present  anatomists,  Dr.  Walter, 
and  almost  everybody  who  makes  a  claim  to  a  liberal  education,  attended  Dr.  Gall's 
Lectures.  He  divides  the  doctrine  into  two  parts — 1st,  The  Doctrine  of  the  Brain  : 
2dly,  The  Doctrine  of  the  Skull — and  gives  an  abstract  of  both.  In  the  March  num- 
ber for  1806  (vol.  xv.  p.  201),  there  is  another  notice,  which  states  that  the  craniology 
of  Dr.  Gall  was  the  favorite  topic  of  the  German  literati,  during  the  summer  of  1805, 
at  almost  every  university  and  capital  of  the  Northern  provinces  of  Germany*  that 
Gall  employed  himself  in  researches  on  the  conformation  and  anatomy  of  the  human 
brain.  The  government  of  Vienna,  however,  forbade  his  lectures.  "But  this  did 
not  stop  his  inquiries'  students  in  physic  and  men  of  research  came  from  every  part 
to  procure  information,  which  he  never  refused,  and  his  doctrine  was  soon  spread  all 
over  Germany  by  the  writings  of  some  of  his  pupils.  The  Doctor  himself  prepared  a 
work,  illustrated  with  copper-plates,  in  which  all  his  striking  observations  on  com- 
parative anatomy  and  the  dissection  of  the  brain  were  to  be  laid  before  the  public. 
Subscriptions  for  it  were  opened,  and  completed  in  a  short  time.  But  previous  to  its 
publication,  the  Doctor  resolved  to  make  a  circuit  of  all  the  Northern  universities  and 
capitals  of  Germany,  in  order  that  the  literati  and  professors  might  hear  and  scruti- 
nize the  lectures  which  he  intended  to  deliver  in  every  place  wherein  he  should 
make  any  residence." 

In  the  July  number  of  the  Edinburgh  Medical  and  Surgical  Journal  for  1806,  will 
be  found  a  very  careful  but  concise  abstract  of  Gall's  Examination  of  the  Brain, 
abstracted  from  all  the  psychical  viewrs  of  its  author,  from  the  pen  of  Professor 
Rosenmuller  of  Leipsic.  In  the  same  number,  there  is  also  a  review  of  Professor 
Bischoff  and  Hufeland's  Account  of  Dr.  Gall's  Cranioscopy,  which  was  looked  upon 
as  a  correct  epitome  of  Gall's  Lectures,  and  of  the  objections  raised  against  his  de- 
monstrations of  the  brain,  and  opinions,  by  Professor  Walter  and  others.  Copies  of 
the  abstract  by  Rosenmuller,  and  of  the  review  of  Bischoff,  I  enclose,  but  shall  be 
glad  to  have  them  returned  at  your  convenience.  Other  notices  exist  in  the  general 
periodicals  of  the  day,  but  these  are  sufficient  to  show  that  Gall  and  Spurzheinr's 
public  dissections  and  demonstrations  of  the  brain  preceded  those  of  Reil  in  Germany  ; 
and  it  is  curious  to  observe  the  influence  they  exerted  in  leading  Reil  to  publish  on 
this  subject  in  1807;  Baron  Cuvier,  in  France,  in  1809;  and  Sir  Charles  Bell,  whose 


PREFACE.  XI 

first  pamphlet  was  circulated  only  among  private  friends,  and  entitled,  "Idea  of  a 
New  Anatomy  of  the  Brain."  The  labors  of  these  eminent  men,  and  their  successors, 
have  indeed  only  been  successful  in  carrying  out  the  details  of  Gall  and  Spurzheirrrs 
general  principle,  that  the  nervous  system  was  not  a  unit,  but  an  aggregation  of  sys- 
tems, as  numerous  as  the  functions,  intellectual,  emotional  or  physical,  of  which  it  is 
the  organized  instrument. 

Believe  me  to  remain,  yours,  very  truly, 
S.  Solly,  Esq.  J.  S.  STREETER. 

There  is  one  point  regarding  the  physiology  of  the  brain  to  which  I 
must  here  advert.  It  is  Dr.  Wigan's  theory  of  the  duality  of  the  mind. 
The  facts  and  reasoning  he  has  brought  to  bear  on  the  subject  are  most 
interesting,  and  his  arguments  are  well  worthy  of  attention.  But  to  do 
it  justice,  and  at  the  same  time  to  criticise  it  judiciously,  would  have 
occupied  more  space  than  I  could  allot  to  the  subject. 

I  have  but  few  words  to  say  regarding  the  pathological  section.  I 
added  it,  because  I  believed  it  would  render  the  work  more  useful,  and 
I  hope  it  may  prove  so,  notwithstanding  the  narrow  limits  to  which  I 
have  been  obliged  to  confine  it. 

With  regard  to  the  Wood-cuts,  I  can  vouch  for  their  general  accuracy: 
they  are  all,  unless  stated  to  the  contrary,  from  drawings  of  my  own,  or 
made  under  my  immediate  inspection.  Some  of  them  I  drew  on  the  wood. 
To  Mr.  Kearney  the  artist,  and  Mr.  Branston  the  engraver,  my  thanks 
are  due  for  the  trouble  they  have  taken  to  execute  them  in  accordance 
with  my  wishes. 

1,  St.  Helen's  Place, 
Aug.  25th,  1847. 


CONTENTS. 


PART  I.— STRUCTURAL  ANATOMY. 
Neurine,  33 — 37 

1.  Gray,  vesicular,  pulpy,  42 — 48 

a.  Source  of  power 

b.  Its  vascularity  • 

c.  Its  phosphatic  quality 

d.  Its  intelligential  agency 

2.  White,  tubular,  fibrous,  37 — 42 

a.  Conductor  of  power 
i.  Nerves  of  sensation 

ii.  volition 

iii.  Excito-motory  nerves 
iv.  Commissures 

b.  Its  chemical  composition 

c.  Its  fibrous  character 

3.  Sympathetic, gelatinous neurine,  34,42-46 

a.  Its  minuteness 

b.  Its  ganglionic  character 

c.  Its  sources  in  the  brain  and  cord 

d.  Its  universality 

e.  Its  mode  of  distribution 
Investing  membrane  of  nerves,  48 
Structure  of  nervous  centres  and  ganglia 

PART  II.— COMPARATIVE  ANATOMY. 

1.  Its  object,  the  elucidation  of  the  several 

functions,  50,  51 
Comparative  anatomy  of  brain 
Nervous  system,  the  medium  of  connec- 
tion with  external  world 
Volition  and  involition  proper  to  nerves 
Consciousness  not  necessarily  proper  to 

nerves 
Nerves,  re-agents  from  within  and  from 

without 

The  simplest  animal  implies  the  existence 
of  a  proper  nervous  system 

2.  The  animal  kingdom,  61,  52 

Five  divisions 
1st.  Cryptoneura 

Nervous  system  indiscernible 
2d.  Nematoneura 

Nervous  system  a  mere  thread 
i.  Ganglia  ) 

ii.  Commissures    >  rudimenlal 
iii.  Nerves  ) 

3d.  Homo-gangliata 

All  the  ganglia  of  one  size 
4th.  Hetero-gangliata 

Ganglia  dispersed  and  separate 
5th.  Myelencephala 
Perfect  brain  and  cord 

1.  Ascaris  or  intestinal  worm 

a.  Its  limited  existence,  52,  53 

b.  Microscopic  thread  of  nerves 
i.  Law  of  development 

ii.  Egg,  at  the  twenty-fourth  hour,  incu- 
bation 


2.  Asterias,  or  star-fish 

a.  Locomotion  for  seeking  food 

b.  Nervous  cords  emanating  from  nervous 

nodules 

i.  A  low  type  of  the  highest  organizations 
ii.  Human  brain  studied  in  its  lowest  ele- 
mentary forms 
iii.  Rudimental  development  of  ganglia, 

commissures,  and  nerves 
Term  ganglion,  not  physiologically  cor- 
rect 

Human  brain,  a  series  of  ganglia 
Nature  of  a  ganglion 
Similarity  between  ganglion  of  the  fifth 

and  posterior  roots  of  spinal  cord 
Cineritious  neurine  is  a  ganglion 
"  Cortical  substance"  a  misnomer 
Peculiarity    of  organism   implies  pecu- 
liarity of  junction 

Gray  neurine   a  ganglion — white  neu- 
rine a  nerve 

Gray  generates,  white  conducts,  power : 
e.  g.  nerves  and  commissures  are  con- 
ductors to  and  fro ;  the  commissures 
are  organs  of  comparison — gray  neu- 
rine the  seat  of  judgment,  &c. 
Diagram  of  the  Phenomena  of  Life-: 
Vital  Phenomena 


Sympathetic,  Spinal,  Cerebral, 

or  or  or 

Cyclo-ganglionic.    Excito-motory.    Brain  system. 


Sensation. 


Locomotion.    Consciousness. 
i         v. i 


Percepuveness.  Intelligence. 

Mind. 


Will. 


Memory.      Understanding. 


Man. 

History  of  ganglionic  nerves,  58 
3.  Articulata 
a.  Spinal  cord,  60 — 62 

Not  the  seat  of  sensation,  nor  of  vo- 
luntary or  instinctive  motion 
Analogy  between  arliculata  and  verte- 

brata 

Symmetrical  nerves  of  Sir  C.  Bell,  the 
analogue  of  the  spinal  cord  of  the 
vertebrata 

Nervous  thread  of  the  lower  is  rudi- 
mental  of  the  spinal  cord  of  the 
higher 

Whenever  the  rudimental  thread  of  the 
lower  terminates  in,  or  is  joined  to 


XIV 


CONTENTS. 


a  gray  ganglionic  centre  or  brain, 
then  there  is  volition 
Comparative  anatomy    works    out   the 
analysis  of  the  functions  in  man 

4.  Tunicata,  62,  63 

Simply  vegetative  life 

Elastic   coating,  the   analogue    of  the 

valvular  conchifera 
In  structure  a  mere  sac,  with  oral  and 

anal  openings,  guarded  by  sphincters 
Rudimental  lungs  or  aerating  surfaces 
Self-procreation  by  germs 
Elastic  coating,  contractile 
The  ganglion  with  nerves  radiating  to 

the  sac  and  its  sphincters 
Tentacular     filaments     fringing     the 

branchial  orifices — nerves  of  sensa- 
tion 
The   sphincters   act   from   consent  or 

sympathy,  analogous  to  the  sphincters 

in  man 

5.  Conchifera,  64,  65 

1.  The  oyster 

a.  No  locomotive  power 

b.  A  particular  muscle  for  closing  its 
shell 

c.  Rudimental  organs  of  vision 

d.  One  ganglion  or  nervous  centre,  the 
analogue  of  the  medulla  oblongata, 
governing  its   respiratory  and  oral 
apertures 

e.  The  smaller  ganglia,  analogues  of 
the    cerebral    ganglia   in  man — or- 
gans of  sense 

2.  Shell-bearing  molluscae 

a.  Locomotion 

b.  Rudimental   foot   implies  additional 

vesicular   neurine — the  pedal  gan- 
glion. 
i.  Brain — consciousness  "*|        0  *i 

ii.  Medul.  oblong,  excilo-  !  .|  § 
motory  and  respiratory  ["lag, 
functions  J  I  J^js 

iii.  Spinal  or  pedal  ganglia  [2~> 
Locomotion  j-£ 

6.  Gasteropoda,  65 

1.  Snail,  slug,  limpet,  &c. 

a.  Sense  of  sight   and"^ 

smell  '  Additional 

b.  Copulation    neces-  f    ganglia 
sary  for  procreationj 

Individuality   of  ganglia    not   decided  by 

anatomical  lines  of  demarkation 
i.  (Esophageal  ganglia 
ii.  Optic  and  olfactory 


v.  Cephalic 
c.  Gustatory  and  manducatory  organs 
i.  Pharyngeal  ganglia 
7.  Myriapoda,  67 — 74 
1.  Sandhopper 

a.  Ganglia   all  one  size   and  at   equal 
distances 

i.  Cephalic       )  Ana-  (Brain  )       i*o  a 

ii.  Respiratory  [  logues  I  Medull.  obi  |       «  «  « 
iii.  Pedal  )     of      (Spinal  cord)  s  o  £-3  ^ 

b.  Commissural    connections  /  £.2  §  | 
i.  Cerebral  com-)    .          TCorp.  call.  1  |  «  g  a  3 

missures          i  ,f "   '  J  transverse  I  |  6-3.2  M 
ii.  Spinal      com-  f  lo^ies  j    fibres  of 
missures        J  cord 


7.  Cymothea 

a.  Nerves  of  instinct — a  distinct  set 

b.  Brain  of  Myriapoda  and  higher  articu- 

lata  composed  of  four  ganglia 

i.  Olfactory  ganglia 

ii.  Hemispherical  and  optic  ganglia 
iii.  Manducatory  ganglia 
iv.  Excito-motory  or  instinctive  nerves 

c.  Sympathetic,  or  ganglion  of  vegetative 

life,  large,  and  chiefly  distributed  to 
the  salivary  glands 
Visceral  ganglia  relatively  large 
Brain  and   nerves  of  sense    relatively 

small,  e.  g.  lulides 
In  insects  this  is  the  reverse 
Visceral  nerves  diminish  in   exact  pro- 
portion to  the   increased  activity  of 
sense  and  motion 

d.  Structure  of  cord — double,  or  composed 

of  two  lateral  columns  with  transverse 
fibres  ;  butterfly 

a.  Reflex  phenomenon 

b.  Fibres  of  reinforcement 

c.  Sensation  and  voluntary  motion 

d.  Pedal  or  tarsal  nerves 

e.  Commissural  connections 
.  f.  Ganglionic  enlargements 

i.  Upper  fibres  )  Joined   to  cephalic 
ii.  Under  fibres  J       ganglia 
iii.  Transverse  fibres    (Commissural 
iv.  Lateral  (connections 

g.  Lateral  fibres  reflex  only 

8.  Crustacea,  74 

Three  divisions  of  nervous  system 
a.  Supra-cesophageal — sensation 
i.  Dorsal  or  spinal  )  Reflex 
ii.  Stomato-gastric  $  functions. 
Exterior  configuration  no  guide  to  identity 

of  function 
1.  Crab 

a.  Ganglia  collected  into  masses 
i.  Cephalic  ganglia,  small 
ii.  Thoracic  ganglia,  large  ;  muscular 
system,  large 

9.  Insecta,  75—78 

Nerves  decidedly  concentrated 
i.  (Esophageal  ring,  a  mass    )  „  .         ,.  , 
ii.  Sensory  ganglia,  large        (  Primordial 
iii.  Pulpy  or  gray  neurine        ) 
Volition  and  consciousness,  e.  g.  moth 

10.  Cephalopoda,  79— 82 

1.  Pearly  nautilus 

Organs  or  ganglia  of  sensation  enlarged 

2.  Cuttle  fish 

a.  First  analogue  of  a  skeleton  for  the 
support  and  protection  of  the  nervous 

r  centres 

b.  Corpus  geniculatum  analogized 

c.  Cardiac  and  solar  plexuses  analogized 
Imperfect  development  of  the  nervous 

masses  harmonizes  with  the  low  or 
imperfect  habitudes  of  animals 
Sensible  mantilla,  the  first  sign  of  the 
excito-motory  system 

11.  Vertebra ta,  82 

Central  masses  exalted  above  the  periphe- 
ral nerves 

Supra-o3sophageal  ganglia  become  a  brain 
in  a  brain-case 

Ganglia  joined  in  a  bony  canal  form  a  spin- 
al cord 


CONTENTS. 


XV 


Brain  and  cord  connected 

Nerves  or  ganglia  reside  in  appropriate 

cavities 

Gray  neurine  enlarged 
A.  Pisces  or  Fishes,  83—92 

i.  Brain  )  True  cerebro-spinal 

ii.  Spinal  cord  J       axis 

Weight  of  brain 

Cord  resembles  human 

Analogous  to  foetal  spinal  cord 

Length  different  in  different  fishes 

Sensory  ganglia,  united  in  man,  are  se- 
parate in  fishes 

"  Origin  of  Nerves"  a  misnomer 

Increased  size   of  hemispheres  argues 
increased  intelligence 

Eight  cerebral  ganglia   enclosed   in  a 
capacious  skull 

Whiting,  Cod,  89 

Hemispherical  ganglia  the  analogues  of 
the  foetal  hemispheres 

Motor  and  sensory  nerves  more  deve- 
loped 

Carp,  Pike,  Skate,  89—92 

Sensory  and  hemispherical  ganglia  still 
more  demonstrable 

Branchiogastric  nerves  analogues  of  the 
pneumogastric.     Electric  ray 

The  brain  more  concentrated  in  carti- 
laginous fishes 

Cerebellum  large  in  skate,  shark,  &c. 
The  locomotive  powers  of  these  fishes 
great,  and  they  have  no  air-bag 

Fifth  pair  of  nerves  visible 

B.  Amphibia,  93 

Hemispheres,  sensory  and  motor  nerves, 
and  cerebellum,  more  developed 

C.  Reptilia,  93—95 

1.  Turtle 
Striking  exemplification  of  the  functions 

of  the  pneumogastric 
Office  of  the  gray  neurine   negatively 
proved 

D.  Aves,  or  birds,  95—97 

Cerebro-spinal  axis  more  decidedly  figured 
Intelligence  and  hemispherical  ganglia  in- 
crease pari  passu 
Convolutions  begin  to  be  seen 
Why  the  brain  is  convoluted 
Cerebellum  large,  and  the  reason  why 
Vermiform  process 

{Implacentalia          (Monotremata 
(Marsupiata 
f~Rodentia 
I  Edentata 
I  Ruminantia 
Placentalia  ^  Pachydermata 

Cetacea 
I  Carnivora 
^Insectivora 

1.  Implacentalia,  97 
Monotremata 
Cloaca  of  birds 
Bird-like  brain 
Relative  weight  of  brain 
Convolutions  almost  absent 
Marsupiata,  99 

Brain  relatively  small 
Absence  of  placenta!  fcetation  typifies  low 
intelligence  and  small  brai'n 

2.  Placentalia,  101 
t 


Rodentia — rabbit 

All  the  parts  of  the  human  brain  here  de- 
veloped 

Convolutions  manifest 
Pons  Varolii  and  medulla  oblongata 
Edentata,  104 
Brain,  simple 
Ruminantia — sheep,  104 

A  more  highly  organized  brain 
Brain  more  oval  in  figure 
Convolutions  distinct 
Cerebellum,  commissures,  thalami  large 
Olfactory  nerve  ;  a  nerve  and  ganglion 

not  identical 
Decussation  of  fibres 
Cerebral  nerves  of  the  base 
Human  brain  now  no  longer  rudimental, 

but  complete 

Pachydermata — horse,  109 
Brain  of  a  high  class 
Gray  and  white  neurine  same  as  in  man 
Medulla  oblongata  bold  and  decided 
Commissures  and  cerebellum  large 

Note: — Ganglia  of  lingual  nerves.     The 
motor  tract  (elephant) :  hemispherical 
ganglia  absolutely  larger  in  man 
The  intelligence  of  the  highly  organized 

brain  of  the  elephant 
Cetacea — porpoise,  112 

As  it  nurses  its  young,  it  so  requires 
intelligence.  Its  highly  organized 
brain 

Plexus  choroides  peculiar 
Nerves  of  sense  large 
Anterior  and  posterior  columns 
The  whale 

Fibrous  neurine  distinct 
Its  relative  weight 
Carnivora 

The  brain  similar 
Insectivora,  116 

Olfactory  nerve  large 
No  convolutions 
The  chimpanzee 

The  figure  of  the  brain  in  the  mammalia 

varies 
Comparative  anatomy  of  particular  parts 

of  the  brain 

Tubercles  of  third  pair,  116—118 
Optic  thalami 
Corpora  striata 
Corpus  callosum,  &c. 
Ventricles 

Convolutions,  118—126 
The  intelligential  ganglia 
Mammalia  classified  according  to  convo- 
lutions 
This  classification  associates  animals  of 

corresponding  faculties 
The  reason  of  the  brain  being  convo- 
luted 

Four  kinds  of  foldings  in  the  convolu- 
tions 

Brain  folded  in  the  progress  of  develop- 
ment according  to  a  determinate  law 
Foldings  more  or  less  according  to  in- 
telligence 
An   attempt  at  a  classification  of  animals  in 

groups  of  similar  convolutions 
Cerebral  vessels,  126—129 


XVI 


CONTENTS. 


Below  man,  the  brain   not  supplied  by  the 

same  set  of  vessels 
In  man — four  arteries 

Contrivance  for  averting  the  heart's  force 
The  rete  mirabile 

Below  man,  varieties  in  the  sets  of  vessels 
supplying  the  brain — instances 

PART  III.  130—144. 
Protective  apparatus  of  the  human  brain 
1.  Osseous,  2.  Membranous,  3.  Aqueous 
Bony  or  osseous 

i.  Dermal  skeleton — external  deciduous 
ii.  Ligamento-bony — internal  permanent 
Its  progressive  development  from  a  cartila- 
ginous tube  up  to  a  jointed  bony  canal 
The  skull — modelled  by  the  brain 
Phrenology 

Mode  of  opening  the  skull 
Membranes  of  the  brain 
Dura  mater  and  its  processes 
Its  arteries  and  nerves 
Reflections  of  the  arachnoid 

Foetal  membranes 
Pia  mater — its  vascularity 

Placental  tufts 

Physiology  of  the  membranes 
Pulsatory   movements   of  the    brain — their 

cause 

Cerebro-spinal  fluid 
Spinal  canal  larger  than  its  contents 
Its  sheath  kept  tense  by  the  fluid 

Senile  dementia  and  atrophy  of  the  brain 
Localities  of  this  fluid 
Nerves  bathed  in  it 
Its  four  confluences 
Changes  its  position 

Spina  bin*  da 

Its  quantity  in  healthy  adult  and  old  age 
Its  rapid  restoration 
Its  use 

Its  chemical  analysis 
Best  manner  of  removing  the  brain 

Base  of  brain  nerves,  &c. 
Best  manner  of  removing  spinal  cord 
The  spinal  canal 
Its  membranes 
Its  plexus  of  veins 
The  spinal  nerves 
The  cauda  equina 
In  what  the  spinal  veins  differ  from  the 

sinuses  of  the  brain 
Ligamentum  denticulatum 
Neurilemma  of  nerves 
Filiform  process 

PART  IV.  145—155. 

Weight  of  human  brain 

Horses',  elephants'  and  whales'  brain 

Metaphysical  and  physiological  remarks  on 
the  properties  of  gray  and  medullary 
neurine 
Average  weight  of  human  brain 

Its  increase,  decrease,  and  final  decay 
Men  of  talent — weight  of  their  brains 
Idiots — weight  of  theirs 
Female  brain 

The  age  at  which  the  brain    is  fully  deve- 
loped 

Tables  showing  the  weight  of  the  brain 
Phrenological  and  physiological  remarks 


PART  V.  156—170. 
Configuration  of  encephalon 
Two  surfaces 

i.  Convoluted  or  external 
ii.  Figurate  or  internal 
Perpendicular  section  of  skull 
An  outline  of  the  entire  brain  and  spinal  cord, 

with  directions  for  dissecting  them 
Convolutions 

A  particular  description  of  their  depth,  order, 

direction  and  foldings 
Figurate  surface 

Dissection  of  hemispheres 
Centrum  ovale 

Important  post-mortem  appearances  of 

this  part  in  insanity 
Lateral  ventricles 

Propriety  of  the  term  "  Cavity" 
Meaning  of  the  term  "Figurate  surface" 
Anterior  cerebral  ganglia  or  motor  columns 
Descriptions  of  the  various  parts  brought  into 
view 

PART  VI.  171—228. 

Dissection  of  the  human  brain  and  spinal  cord 
Mode  of  hardening  the  brain  for  dissection 
Spinal  cord 

Two  halves,  with  anterior  and  posterior  fis- 
sure 
Thirty-two  nerves 

i.  Smaller  anterior  or  motor 
ii.  Larger  posterior  or  sensatory 
Each  posterior  root  furnished  with  a  ganglion 
Continuity  of  nerves  with  the  gray  neurine  of 

cord 

Transverse  section 
An  internal  canal 
Gray  neurine  within,  a  series  of  ganglia  with 

commissural  connections 
Fibres  of  the  cord 
Motory  and  sensory  fibres 

Opinions  of  the  older  physicians,  180 
Comparative  anatomy  of  cord 
Cranial  division  of  the  cerebro-spinal  axis, 

181 
Medulla  oblongata 

Gray  neurine,  how  disposed 
Six  ganglia 

i.  Two  anterior — motor  root  of  the  fifth 
ii.  Two  lateral — pneumogastric 
iii.  Two  posterior — auditory 

Comparative  anatomy 
Decussation  of  pyramidal  bodies 
Its  pathological  importance 
Opinions  of  the  older  physicians  and  of 

modern  pathologists 
The  mode  of  decussation 
Line  of  demarkation  between  the  tracts  of  sen- 
sation and  motion,  1S7 
The  distinct  offices  of  the  two  spinal  columns, 

not  an  anatomical  distinction 
Pons  Varolii — distribution  of  the  decussating 

fibres 
Mode  of  dissecting  medulla  oblongata,  192 — 

196 

Dissection  of  the  fibres  of  the  motor  columns 
Cerebral  fibres  of  the  sensory  columns 
Decussation  behind  the  pons  Varolii 
Mode  of  demonstrating  it 
Mode  in  which  nervous  matter  is  finally  appro- 
priated to  sensation  and  motion,  200 


CONTENTS. 


XV11 


Diagram  of  Reflex  Functions. 
Brain. 


Gray  neurine 


Medullary  neurine. 

Volition.  Motion.      Sensation. 

Spinal  Cord. 


^   (£2 

Anterior        .   Posterior 
Column.    >,S   Column. 

_          cs  •£  __ 

Motor     O  S  Sensory 
Nerves.        G  Nerves. 


Peripheral 
surface. 

The  perpendicular  arrows  may  represent  the  fibres 
of  reinforcement.  The  horizontal  arrow  may  repre- 
sent the  transverse  commissural  fibres  of  the  cord. 

Dissection  of  the  fibres  of  the  sensory  tract 
The  structure  of  the  hemispherical  ganglia,  204 

Section  of  the  cerebrum 

Distribution  of  gray  neurine 

Medullary  fibres  pass  into  and  through  gray 
matter 

Externaf  layer  of  the  gray  matter  is  white 

Comparative  anatomy 
Commissures 

Definition  of  the  word 

Note  :  Commissure  of  the  star-fish 

Transverse  commissure 

Lateral  ventricles 

Note:  The  ventricles  are  not  cells 
The  other  commissures 

Longitudinal 

Commlssura  mollis 
Pons  Varolii,  fornix,  &c. 
Inter-cerebral  commissure 

Arrangement  of  its  fibres 

Arbor  vita? 
The  cerebellum,  217 

Its  situation,  shape,  and  relations 

Mode  of  preparing  it  for  dissection 

The  vermiform  process 
Comparative  anatomy 

Connection  with  the  pons  Varolii 

The  course  of  its  fibres 
Comparative  anatomy 
Tuber  cinereum,  &c. 
Recapitulation 

PART  VII.  229—240. 
Cerebral  nerves 

Opinions  respecting  their  precise  numbers 
Eleven  pairs  described 

Decussation  or  semi-decussation  of  optic  nerves 
Theory  of  vision 

PART  VIII.  241—243. 
Cerebral  circulation 

PART  IX.  244—256. 
Development  of  the  brain 
Facts  prove  the  law  of  progressive  develop- 

ment 
A  brief  outline  of  the  passing  comparative  ana- 

tomy of  the  fetal  existence 

2 


PART  X.  257—268. 
Physiology  of  the  cerebro-spinal  axis 
Phrenological  observations 

PART  XL  269 — 484. 
Diseases  of  the  brain 
Arrangement 

A.  Anaemic  affections 

B.  Hyperaemic  affections 

C.  Convulsive  affections 

D.  Organic  affections 

History,  diagnosis  and  treatment  not  strictly 

divided 
Variableness  in  the  amount  of  blood  within  the 

calvarium 
Authorities  maintaining   that  the   amount    of 

blood  never  varies 
Authorities  maintaining  the  reverse 

Experiments  proving  the  ebb  and  flow  of 

blood  within  the  skull 

A.  Anaemic  affections 
Diminished  flow  of  blood 

Instances  of  cutting  off  the  arterial  supply 
Effect  on  cerebrum  from  obliterating  one 

of  the  carotids 

Effect  of  tying  carotid  in  epilepsy 
Effect  of  ingurgitation 

1.  Delirium  tremens 

Its  seat — hemispherical  ganglion  (?) 

a.  Venous  canals  charged 

b.  Opacity  of  arachnoid 

c.  Effusion 

Effect  of  light  in  delirium  tremens  and  in 

mania,  compared 
Two  kinds 
i.   Proximate 
ii.  Consecutive 

Hysteria,  is  it  anaemia  of  the  brain  ? 
The  nature  of  delirium  tremens  sometimes  in- 
flammatory 

Treatment : — use  of  opium,  stimulants,  bleed- 
ing, &c. 
Diagnosis — the  pulse  r-  «J«>:, 

2.  Anaemic  coma,  281—288 

i.  Coma.     ii.  Hydrocephalus.    iii.  Ratnollisse- 

ment 

i.  Coma  from  exhaustion — infants 
Nature,  signs,  and  treatment 

from  erysipelas  capites 

Proper  treatment 
ii.  Cerebral  anaemia,  289 
Effect  of  mental  exertion 
Nature,  signs,  and  treatment 
iii.  Ramollissement,  291 

Cause  and  period  of  accession 
Its  nature — hypersthenic,  or  asthenic? 
Remarks  on  the  condition  of  the  blood- 
corpuscles 
Two  kinds  of  ramollissement 

i.  Inflammatory  )  Pathology 

ii.  Non-inflammatory    5      of  each 

3.  Atrophy  of  brain,  302 
Arrest  of  development  (?) 
Gives  rise  to  effusion  in  children 

Hydrocephalus 

The  result  of  chronic  inflammation 
i.  Fatuity 
ii.  Mania 
iii.  Old  Age 

B.  Hyperaemic  affections,  303,  304 


XV111 


CONTENTS. 


i.  Inflammation  of  brain,  from  within 

ii.  • ,  from  without 

Internal  inflammation  of  brain 

1.  Inflammation  of  cortical  substance 

2.  medullary  matter 

3.  — — — — ^  base 

4. cerebellum 

Caution  as  to  the  report  of  post-mortem  ex- 
aminations 

Morbid  signs  of  inflammation  of  the  several 

membranes  and  the  neurine  , 

1.  Inflammation  of  hemispherical  ganglia 

Its  effects  and  symptoms,  307 

Intelligence  excited  or  deranged 

Volition  impaired  or  exaggerated 

Meningitis  ) 

Arachnitis  >  meaning  of  these  terms 

Phrenitis      ) 

Symptoms,  313 

Mania — its  probable  organic  lesions 

An  account  of  the  mental  and  bodily  dis- 
turbances 

The  great  importance  of  attending  to  the 
particular  kind  of  effusion,  mania,  de- 
lirium, or  headache 

The  intellectual  faculties  to  be  well  observed 

and  considered 
Concussion,  316 

Intellect  deranged  or  abolished 

Meningitis — its  effects  often  insidious 

A  remote  cause  of  insanity 

Treatment 

Antiphlogistic — to  what  extent 
Fractures  of  the  skull 

Inflamed  dura  mater 

Otitis  or  earache — its  importance 

Syphilitic  taints 

Ossifications 

Causing  mental  irritability  or  insanity 
Skull    often    thick   or    hypertrophied    in 

mania 
Treatment 

Strictly  antiphlogistic 

Scarlatina — its  sequel,  meningitis 

Treatment  of  inflammation  of  brain 

a.  Value  and  extent  of  bleeding 
Pathology  of  insanity 

b.  Purgatives 

c.  Cold 

d.  Various  other  remedies 

Treatment  of  insanity 

e.  Proper  use  of  mercury,  opium,  &c. 

f.  Erect  or  recumbent  position 

g.  Darkness,  silence,  &c. 
Apoplexy,  363 

An  indefinite  term 
Pressure  on  the  brain 
Symptoms 

Its  real  and  aberrant  forms 
It  may  resemble  sleep,  syncope,  or  epilepsy 
Three  forms 

i.  Apoplexy  with  coma 

ii. headaches 

Hi.  palsy  or 

paralysis 

or 

i.  Sanguineous  apoplexy 
ii.  Serous  apoplexy 
iii.  Simple  apoplexy 

Another  form  may  be  added 
iv.  Congestive 


Predisposing  causes  specified 

Cardiac  disease 
Premonitory  symptoms 
Effects  of  apoplexy 

Its  most  fatal  form 

Its  least  fatal  form 
Lesions  of  corp.  striat.,  375 

thalam.  nerv.  opt.,  376 


medullary  substance 

Meningeal  apoplexy,  378 
Its  localities 
Its  consequences 
Its  intellectual  injuries 
Its  acute  pain 
Apoplexy  of  cerebellum 

Effusion,  affecting  the  limbs  of  the  same  side 
Observations  on  sanguineous  apoplexy,  and 

its  resemblance  to  epilepsy 
Serous  apoplexy 

Arrest  of  respiration 
Passive  congestion 
Determination  of  blood  to  the  head 
Apoplectic  fever  at  Madras 
Treatment,  392 

Of  premonitory  symptoms 
Treatment  of  apoplexy  itself 
Sthenic  or  asthenic 
The  promptitude  and  decision  requisite  for 

success 

The  symptoms  indicating  or  contra-indicat- 
ing the  loss  of  blood 
Rules  for  the  extent  of  bleeding 
Danger  of  bleeding  without  absolute  neces- 
sity 

Danger  of  calomel  in  apoplexy 
Cold,  croton  oil,  &c.  &c. 
The  after  treatment 
C.  Convulsive  affections,  405 — 421 
Their  seat  in  tubular  neurine 
Convulsions  on  one  side  indicate  disease  on 

the  other 

The  result  of  pressure 

Injuries  to  the  head  give  rise  to  convulsions 
Fractures  of  the  skull 
Trephining 

Opening  the  dura  mater 
Pulsatory  movements  of  dura  mater 
Epilepsy,  423—463 

Opinions  of  the  older  physicians 
Its  outward  signs 
Associated  with  mania 
Frequency  of  the  fits 
The  mild  or  half  attacks 
Disturbance  of  intellect 
Forewarnings 
Their  varieties 
Aura  epileptica 

Portion  of  radial  nerve  removed  for  it 
Its  probable  nature 
Fits  from  dentition 
Brutes  subject  to  epilepsy 
Post-mortem  examinations 
Bony  deposits 
Morbid  growths 

[rritation  of  the  excito-motory  system 
Two  kinds  of  epilepsy 

Centric  and  centripetal^ 
Causes  of  epilepsy 
Cerebral  disease 
Gastro-hepatic  irritation 
Generative  disorders 


CONTENTS. 


XIX 


Determinations  of  blood  to  the  head — the  cho- 

roid  plexus 
Headaches  in  epilepsy 

Theory  of  the  pathology  of  epilepsy 
Various  opinions  respecting  the   seat  of  the 

disease 
Hyperaemia  of  the  brain  during  the  epileptic 

paroxysm 

The  use  of  digitalis 
GEnanthe  crocata 
Effects  of  tying  the  carotid 
Th-robbings  of  the  carotids 
Mental  excitement 
Cold,  a  cause  of  epilepsy 
Remote  causes  of  epilepsy 
Venereal  poison 
Inflammation  of  dura  mater 
Prognosis  in  epilepsy 

The  various  causes  and  kinds  of  epilepsy 

seen  in  practice 

Determinations  of  blood  to  the  head 
The  pulse  in  epilepsy 
Treatment 

Local  and  therapeutic 
Aperients 
Bleeding 

Oxyde  of  silver,  zinc,  &c. 
Digitalis 

Its  modus  operandi 
Shower  bath 

D.  Organic  diseases  of  the  brain,  463 — 484. 
Morbid  growths  from  neurine,  or  the  mem- 
branes not  the  result  of  simple  hyperaemia 
Tumors  within  the  skull,  463 

Mercury  and  its  iodurets 

The  ordinary  reports  of  these  cases  almost 
valueless 


Dura  mater 

Tumors  outside  of  the  membrane  absorbing 

the  bone  and  protruding  outwards 
Malignant  or  cancerous  growths 

Diagnosis  difficult 

Pulsatory  movements  of  the  brain 

Ulceration  of  the  integuments 
Apoplectic  terminations 
Inflammatory  tendencies 
Non-malignant  growths 

Their  various  characters 

Hydatids  of  plexus  choroides 
Haematoma  of  the  brain 
The  best  pathognomonic  signs 

Headaches — their  character 

Vomitings — their  kind 

Organs  of  sense  disturbed 

Convulsions  and  their  form 

Paralysis 

Gastro-hepatic  disorders 

Giddiness — of  what  sort 
Hypertrophy  of  the  brain,  477—484 

Brain  hypertrophied  like  the  heart 

A  result  of  fatal  precocity 

Its  post-mortem  character 

Induration  of  the  brain 

The  kinds  of  hypertrophy 

Simulates  hydrocephalus 

Its  causes  obscure 
Relative  weight  of  brain  in  disease 

The  co-existence  of  enlarged  thymus  gland 
The  aspect  of  passive  hypertrophy 
Constitutional  symptoms 
Distinction  between  hypertrophy  and   hydro- 
cephalus 
The  treatment 


*T« 


THE 

HUMAN    BRAIN. 


PART  I. 

STRUCTURAL  ANATOMY. 

BEFORE  we  commence  our  study  of  the  configuration  and  anatomical 
arrangement  of  the  human  brain,  we  must  investigate  the  physical,  che- 
mical, and  microscopical  character  of  its  component  matter.  The  name 
of  this  matter  is  NEURINE.  Neurine  is  the  substance  in  which  the  pecu- 
liar powers  of  the  brain  and  nerves  reside.  It  is  never  found  by  itself, 
for  it  is  too  delicate  in  texture  to  retain  its  properties  if  it  were  unsup- 
ported. It  is  always  supported  and  protected  by  the  membranous  fibre 
arranged  in  various  ways. 

In  the  construction  of  the  nervous  system,  the  plan  is  the  same  as  that 
which  prevails  in  all  the  other  systems  of  an  organized  being.  Mem- 
branous matter  forms  the  basis  of  each  organ,  in  the  interstices  of  which 
the  peculiar  material  of  the  organ  is  deposited.  The  bones  consist  of  a 
membranous  network,  in  the  interstices  of  which  the  earthy  matter  is 
deposited,  giving  them  the  solidity  required  for  the  performance  of  their 
office. 

Muscles  consist  of  a  membranous  network,  in  the  tubular  meshes  of 
which  fibrinous  matter  is  placed,  which  is  endowed  with  the  power  of 
contraction,  on  the  application  of  its  appropriate  stimulus.  Glands 
consist  of  a  membranous  network,  on  which  blood-vessels  ramify,  en- 
dowed with  the  power  of  separating  or  secreting  from  the  blood  a  pecu- 
liar fluid;  the  liver  forming  bile,  the  salivary  glands  saliva,  the  kidneys 
urine,  &c. 

The  glands  consist  of  two  portions,  the  secreting  portion  and  the  con- 
ducting portion.  In  the  one  portion,  in  addition  to  the  membrane,  there 
are  nucleated  cells;  in  the  other  there  are  tubes.  By  the  one  portion, 
the  fluid  is  formed ;  by  the  other,  it  is  conducted  to  the  place  where  it 
is  required. 

The  essential  material  of  the  nervous  system  is  denominated  Neurine. 
Some  anatomists  still  persist  in  calling  it  nervous  matter,  but  it  appears 
to  me  wrong  to  use  two  words  where  one  expresses  the  thing  to  be  de- 
scribed much  better. 
3 


34  STRUCTURAL   ANATOMY. 

There  are  two  kinds  of  neurine,  differing  in  color,  consistence,  and 
microscopic  character.  They  are  easily  recognized,  and  soon  known  to 
the  anatomist.  They  are  well  seen  in  the  brain  of  Man,  and  in  the 
Mammalia  generally.  The  one  is  of  a  gray  or  ash  color,  and  pulpy 
texture,  as  seen  by  the  naked  eye,  and  roughly  examined ;  and  hence 
its  title  cineritious,  or  pulpy  neurine.  With  the  microscope  it  has  been 
discovered  to  consist  of  nucleated  cells  or  vesicles,  and  therefore  more 
justly  denominated  vesicular  neurine.  The  other  is  of  a  pearly  white 
color  and  fibrous  texture:  this  is  medullary  or  fibrous  neurine.  The 
difference  in  texture  depends,  in  all  probability,  more  on  the  arrangement 
of  the  supporting  membrane  than  upon  any  physical  difference  between 
their  elementary  particles. 

Under  the  microscope,  the  fibrous  neurine  is  found  distinctly  to  con- 
sist of  tubes,  and  hence  its  present  title,  tubular  neurine.  A  third  kind 
has  been  described  to  exist  in  those  nerves  which  have  been  long  known 
to  the  anatomist  as  the  sympathetic.  To  the  naked  eye,  this  appears 
almost  identical  with  the  cineritious  neurine  of  the  brain,  and  has  been 
generally  classed  as  cineritious  neurine;  but  it  has  been  lately  denomi- 
nated, from  its  microscopic  character,  filamentous  or  gelatinous  neurine. 
Its  filaments  are  about  half  the  diameter  of  those  of  the  tubular,  and 
without  any  distinct  cavities.  This  neurine,  as  will  be  shown  hereafter, 
is  merely  the  tubular  neurine  without  an  investing  layer. 

The  revelations  of  the  microscope  regarding  the  ultimate  texture  of 
these  different  kinds  of  neurine,  are  most  deeply  interesting,  and  quite 
determine  the  correctness  of  the  view  advocated  in  the  first  edition  of 
this  work,  of  their  relative  function.  This  view  of  the  subject  is  now 
almost  universally  admitted;  but  in  the  year  1836,  it  was  by  no  means  an 
established  point  in  physiology.  The  view  to  which  I  refer  is  this:  that 
the  cineritious  neurine  is  the  source  of  power,  and  the  medullary  neurine 
merely  the  conductor  of  it.  The  importance  of  establishing  this  position 
will  be  best  understood  when  we  come  to  the  dissection  of  the  human 
brain  and  spinal  cord,  and  endeavor  to  discover  the  office  of  its  compo- 
nent parts.  Until  this  point  was  established,  (and  even  now  it  is  not 
considered  to  be  so  by  all,)  the  study  of  the  anatomy  of  the  brain  was 
barren  and  fruitless.  Our  predecessors  had  some  glimmering  of  light 
on  the  subject,  but  their  opinions  were  various  and  unsettled. 

Lauth  considered  the  gray  substance  as  only  a  preparing  organ. 
Treviranus  says  that  it  prepares  the  blood  for  particular  processes  which 
go  on  in  the  medullary  substance.  Vieussens,  that  it  prepared  and 
purified  lymph  as  nourishment  for  the  medullary  substance.  According 
to  Berenger,  it  is  said  to  assimilate  the  living  spirits  of  the  blood,  and 
to  metamorphose  it  into  animal  spirits.  Sylvius  imagines  it  evaporates 
the  water  from  the  spirits,  as  by  distillation,  and  purifies  them.  Diemer- 
broeck,  Ruysch,  Haller,  and  others,  entertained  the  same  opinion. 

Meckel  says*  that  "  the  most  probable  hypothesis  is  that  which  repre- 
sents the  gray  and  medullary  substances  as  two  masses,  the  opposition 
or  contrast  of  which  results  from  the  difference  which  exists  in  their 
structure  and  chemical  composition,  and  is  necessary  to  the  accomplish- 

•  Vol.  i.  p.  256. 

e 


OPINIONS.  35 

ment  of  the  functions  of  the  nervous  system;  and  that,  however  incon- 
testable the  importance  of  the  gray  matter,  it  does  not  authorize  us  to 
believe  that  it  is  more  noble  than  the  medullary:  that  is  to  say,  that  in 
this  portion  the  spiritual  changes  corresponding  to  the  material  pass  into 
one  another,  as  Wenzel  appeared  to  believe  when  he  says,  *  Cinerea 
singularum  cerebri  partium  substantia  videtur  prrecipue  id  esse,  quo 
propriae  cuivis  istarum  partium  sensationes  efficerentur;'*  and  that  the 
office  of  the  medullary  is  not  simply  that  of  a  conductor." 

Not,  however,  agreeing  with  Meckel,  but  rejoicing  to  derive  support 
to  my  opinions  from  such  accurate  observers  as  the  Wenzels,  I  shall 
quote  the  whole  passage :  "  Verisimiliter  itaque  diversor  singularum 
cerebri  partium  functiones  maxima  saltern  ex  parte  a  cinerea,  mutua 
autum  singularum  cerebri  partium  conjunctio,  totiusque  nervus  a  medul- 
lari  substantia  dependet ;  sive  quod  idem  est :  cinerea  singularum 
cerebri  partium  substantia  videter  prascipue  id  esse,  quo  propriaB  cuivis 
istarum  partium  sensationes  efficerentur,  et  substantia  medullaris  eadem 
modo  pro  reliquo  cerebri  ductor  impressionum  sive  sensationum  singu- 
larum cerebri  partium  esse  videtur,  rion  secus  nervus  sensoriusid  ipsuni 
suo  organo  prsestat." 

Willis  (Anatomy  of  the  Brain,  translated  by  S.  Pordage,  1679,  p.  59), 
says,  "  And  what  is  chief  of  all,  the  universal  cortical,  or  shelly  sub- 
stance of  the  brain,  (to  wit)  in  which  the  animal  spirits  are  procreated." 
A  little  further  on,  he  says,  "  The  callous  body  is  rather  designed  for  the 
circulation  than  the  generation  of  spirits."  He  considered  that  the 
animal  spirits  which  the  gray  substance  secretes,  are  circulated  by  the 
medullary.  Reil,  (Mayo,  Physiological  Commentaries,  Part  II.  p.  117,) 
speaking  of  the  fornix,  says,  "  Like  these,  the  corpus  callosum  involves 
no  gray  matter,  and  with  them  perhaps  forms  an  apparatus  for  transmis- 
'sion  only." 

Even  Gall  and  Sptirzhetm,  who  have  done  so  much  for  the  anatomy 
and  physiology  of  the  brain,  did  not  see  clearly  the  relation  of  the  cine- 
ritious  neurine  and  the  medullary.  They  considered  the  former  as  the 
womb  or  generator  of  the  medullary  substance. 

Tiedemann,  as  will  be  seen  from  the  following  passage,  does  not  con- 
sider it  as  the  sole  agent  in  the  production  of  power,  but  merely  as  an 
instrument  to  exalt  and  increase  that  which  is  already  generated  by  the 
nerves. 

"  The  quantity  of  gray  substance,"  says  Tiedemann,  "  in  those  parts 
of  the  spinal  marrow  from  whence  issue  the  large  nervous  trunks,  and 
which  receives  so  many  vessels  that  Ruysch  imagined  it  entirely  vascular, 
contributes  certainly,  during  life,  to  increase  and  exalt  the  nervous  action, 
according  to  this  general  law,  that  an  organ  possesses  more  force  and 
energy  as  it  receives  more  arterial  blood.  M.  Gall  is  deceived  in  saying 
that  the  gray  substance,  which  he  terms  the  womb  of  the  nerves,  is  the 
first  formed,  being  the  producer  and  nourisher  of  all  the  nerves.  I  allow, 
with  him,  that  it  strengthens  and  fortifies  the  action  of  those  parts  of  the 
brain  and  nerves  which  emanate  from  it,  in  as  much  as  this  effect  is  pro- 
duced by  the  arterial  blood  which  it  contains,  and  by  the  greater  rapidity 

*  De  Penitiori  Cerebri  Structur4,  cap.  vi.  p.  69. 


36  STRUCTURAL   ANATOMY. 

with  "which  it  repairs  the  loss  which  the  exercise  of  the  vital  action  pro- 
duces. I  admit,  then,  an  intimate  relation  between  the  volume  of  the 
spinal  nerves  and  the  enlargements  of  the  spinal  marrow  in  those  points 
from  whence  these  nerves  issue.  It  is  very  easy  to  be  convinced  of  this 
in  fishes,  where  the  origins  of  the  nerves  produce  particular  ganglia, 
always  when  the  nerves  and  the  organs  to  which  they  are  distributed 
have  acquired  a  greater  development,  or  when  there  are  particular  organs 
not  found  in  other  fishes.  The  remarkable  and  regularly  disposed 
enlargements  observed  immediately  behind  the  cerebellum  in  the  flying- 
fish  (Triglavolitans*))  are  the  origins  of  the  nerves  destined  to  the  digi- 
tiform  prolongations  peculiar  to  these  fishes,  observed  in  front  of  the 
ventral  fins,  and  provided  with  numerous  muscles,  serving  at  the  same 
time  as  organs  of  touch  and  progression  ;f  of  this  I  have  been  convinced 
for  some  years.  We  find  also  in  the  torpedo  (Raia  Torpedo)  two  large 
ganglia,  situated  also  behind  the  cerebellum,  the  size  of  which  they 
much  surpass,  and  from  whence  issue  the  nerves  analogous  to  the  eighth 
pair,  which  furnish  a  great  number  of  branches  to  the  electrical  organs 
of  these  fishes.  The  Raia  clavata,  Raia  Batis,  Raia  Pastinaca,  and 
other  species  of  the  skate  properly  called,  present  but  a  very  small 
swelling,  giving  origin  to  the  eighth  pair,  which  in  these  animals  are 
only  distributed  to  the  gills.  In  the  sheaf-fish  (Silurus)  the  origin  of  the 
fifth  pair  of  nerves  forms  a  very  voluminous  mass,  because  this  pair 
sends  large  branches  to  the  long  barbules  which  cover  the  superior 
maxilla,  and  to  the  muscles  of  these  appendages.  We  find  similar 
enlargements  along  the  spinal  marrow  of  most  fishes. i  Thus,  for  ex- 
ample, in  the  carp,  there  are  behind  the  cerebellum  two  swellings,  united 
together  by  a  middle  tubercle,  and  representing  in  some  degree  a  second 
cerebellum.  We  cannot  then  doubt  that  the  local  augmentation  of  the 
mass  of  the  spinal  marrow,  by  the  addition  of  a  greater  quantity  of  this' 
substance,  is  to  exalt  the  action  or  activity  of  the  nerves  which  emanate 
from  these  ganglia. "§ 

One  of  the  first  physiologists  who  decidedly  advanced  the  opinion 
that  the  gray  neurine  is  positively  a  source  of  power,  was  Dr.  Fletcher,  || 
of  Edinburgh.  In  his  Lectures,  when  speaking  of  the  distinction  be- 
tween a  plexus  and  a  ganglion,  he  says,  uThe  abundance  of  gray  mat- 
ter which  they  contain,  and  which  there  is  good  reason  to  believe  is  always 
a  primary  source  of  some  distinct  faculty  or  power,  &c."1F  And  again, 
in  another  part  of  the  same  course  of  lectures,  he  says: 

41  It  is  probable  that  no  impediment  whatever  is  offered  to  the  function 
of  a  ganglionic  nerve  by  such  a  division  as  entirely  paralyzes  the  cere- 
bro-spinal.  Such  is  the  case  with  the  latter  only  ;  because  the  white 

*  Samuel  Collins  has  described  and  represented  them, — System  of  Anatomy,  vol.  ii.  tab. 
70,  fig.  3. 

+  This  I  have  demonstrated  in  a  Memoir  addressed  to  the  Academy  of  Sciences  at  Berlin. 

I  Arsakay,  foe.  cit.  p.  16.     De  posteriore  Gangliorum  Encephalum  constituentum  Parte. 

§  Tiedemann  on  the  Foetal  Brain,  translated  by  Bennet. 

||  It  is  with  great  pleasure  that  I  embrace  this  opportunity  of  expressing  the  high  opinion 
I  entertain  of  the  late  lamented  Dr.  Fletchers  talents  and  philosophical  mind.  Dr.  Fletcher 
had  the  honor  of  being  among  the  first,  if  not  the  very  first  lecturer  in  the  kingdom  who 
taught  human  physiology  on  the  wide  and  scientific  basis  of  comparative  anatomy. 

\  Ryan's  Journal,  April  18,  1835,  page  961,  note. 


OPINIONS.  37 

matter  of  the  nerve,  being  dependent  for  its  energy  upon  the  gray  mat- 
ter of  the  central  parts  of  this  system,  becomes,  of  course,  inert  when 
separated  from  it:  but  no  such  line  of  demarkation  exists  in  the  gan- 
glionic  system,  every  point  of  every  nerve  of  which  contains  white  and 
gray  matter  intimately  interwoven  together,  and  may  be  considered, 
therefore,  as  a  centre  of  nervous  energy  to  itself;  and  it  is  in  this  way 
only  that  we  can  explain  how  the  total  removal  of  a  muscle  from  the 
rest  of  the  body,  which  implies  a  division  as  well  of  its  blood-vessels  as 
its  nerves,  is  not  for  some  time  effectual  in  destroying  its  irritability." 

As  the  student  advances  in  the  study  of  the  structure  and  physiology 
of  the  brain,  he  will  see  many  reasons  for  assenting  to  this  view  of  the 
office  of  the  cineritious  neurine,  which  cannot  be  fully  appreciated  with- 
out a  further  knowledge  of  the  subject  than  he  is  supposed  to  possess  at 
present.  We  believe  then  that  the  peculiar  power  of  the  nervous  sys- 
tem resides  in  the  cineritious  portion.  In  short,  that  the  cineritiolis 
portion  of  the  nervous  system  stands  in  the  same  relation  to  the  rest  of 
that  system  as  the  secreting  portion  of  a  gland  does  to  the  rest  of  that 
organ,  though  one  portion  would  be  useless  without  the  other.  The 
medullary  or  tubular  neurine  appears  to  act  simply  as  a  passive  con- 
ductor of  the  power  generated  by  the  vesicular  neurine,  not  possessing 
any  control  over  that  power,  not  capable  of  acting  upon  it  or  changing  it. 

Thus  we  find  tubular  neurine  performing  various  offices: 

1st.  As  a  conductor  of  an  impression  from  the  surface  of  the  body  to 
the  brain — a  nerve  of  sensation. 

2dly.  As  a  conductor  of  an  order  to  act,  from  the  brain,  to  the  volun- 
tary muscles — nerve  of  volition. 

3dly  and  4thly.  As  a  conductor  of  an  impression  from  the  surface 
of  the  body  to  the  spinal  cord,  which  is  reflected  thence  down  another 
set  of  conductors  to  the  muscles  whereby  they  are  called  into  action, 
independently  of  volition — the  exdto-motory  nerves  of  Dr.  M.  Hall. 

5thly.  As  a  conducting  medium  between  the  centres  of  power — the 
commissures. 

Further  explanation  will  be  given  hereafter  of  the  function  of  the 
nerves  of  sensation,  the  nerves  of  motion,  the  excito-motory  nerves,  and 
the  commissures.  One  simple  pathological  fact  will  now  be  sufficient 
to  illustrate  the  distinction  between  the  power  of  the  nervous  centres 
and  their  conducting  instruments,  and  show  that  the  central  portion  pos- 
sesses its  power  independent  of  the  peripheral.  A  patient  may  be  para- 
lytic from  disease  affecting  the  motor  tract ;  the  individual  as  perfectly 
retains  the  power  of  willing  the  motion  of  his  limbs  as  previous  to  the 
occurrence  of  the  disease,  though  his  will  is  no  longer  conducted  to  the 
point  where  it  would  be  executed.  But  this  illustration  does  not,  of 
course,  afford  the  slightest  explanation  of  the  mode  of  action  of  these 
two  parts,  nor  need  it  imply  a  belief  in  the  necessity  of  a  physical 
change  for  the  production  of  nervous  action. 

Tubular  or  medullary  neurine,  though  firmer  than  the  cineritious  neu- 
rine, nevertheless,  in  comparison  with  the  other  tissues  of  the  body,  is 
soft  and  yielding. 

This  want  of  tenacity  is  principally  owing  to  the  large  quantity  of 
water  which  enters  into  its  composition;  water  actually  constituting 


38  STRUCTURAL   ANATOMY. 

from  three-fourths  up  to  seven-eighths  of  its  weight.  Vauquelin,  whose 
analysis,  though  made  as  long  ago  as  1812,  is  still  referred  to  by  all 
our  best  authorities  as  most  deserving  of  credit,  states  that  the  brain 
consists  of 

Albumen  .... 

r^.  1,^1  fof  Stearine     4-53 

Cerebral  fat          . 

Phosphorus  . 

Osmazome  ..... 
Acids,  salts,  Sulphur  ..... 
Water 

100-00 

M.  John*  is  the  only  chemist  who,  in  his  analysis  of  the  brain,  has 
hitherto  separately  examined  the  gray  and  white  matter.     He  has  stated 
that  the  white  matter  contains  more  fat  than  the  gray,  and  that  its  albu- 
men is  more   firm.     The  following  comparative  analysis  was  made  of 
the  brain  of  one  of  the  insane  patients  who  died  at  Salpetriere. 

Entire  brain  (density  =  1048). 

Water      .             .             .             .             .             .  77-0 

Albumen               .....  9-6 

White  fatty  matter             ....  7-2 

Red  fatty  matter  .             ,             .             .             .  3-1 

Osmazome,  lactic  acid,  and  salts  .             .             .  2-0 

Earthy  phosphates             .             *             .             .  1-1 

White  Substance.  Gray  Substance. 

Water             .             .             .  73-0  .  85-0 

Albumen        ...  9-9  .  7-5 

White  fatty  matter      .             .  13-9  .  1-0 

Red  fatty  matter          .            V-  0'9  .  3-7 

Osmazome,  &c.           .          {  ^  I'O  .  1-4 

Earthy  phosphates      .  1-3  1-2 

Foville  states  that  the  brain  of  a  fat  man  contains  a  much  larger 
quantity  of  fatty  matter  than  that  of  a  thin  man;  also  that  the  brain  of 
the  Cetacea  contains  a  large  quantity  of  oil :  that  the  brain  wastes  with 
the  rest  of  the  body ;  but  the  fat  of  the  brain  is  combined  in  so  intimate 
a  manner  with  its  substance,  that  it  never  forms  solid  and  visible  isolated 
masses  external  to  the  nervous  matter. 

"  The  presence  of  fat,"  says  this  author,  "  in  proportion  to  its  amount, 
gives  a  more  rich  form  and  more  rounded  contour  to  all  the  surfaces  of 
the  nervous  centres.  Its  absence  alters  these  forms,  rendering  them 
poor  and  sharp.  With  its  absence  coincides  the  increase  of  free  serosity 
in  the  internal  cavities,  and  those  which  separate  the  convolutions."! 

He  also  in  some  cases  attributes  to  emaciation  the  peculiar  appearance 

*  Journal  de  Chimie  Medicale,  August,  1835. 

•j-  Trait6  complet  de  I'anat6  de  la  physe  et  de  la  path*  du  systeme  nerveux  Qe.reb°.  8vo, 
1844,  par  Foville,  p.  122. 


TUBULAR   NEURINE. 


Fig.  1. 


of  the  brain  of  old  people,  though  at  the  same  time  warning  us  from 
confounding  this  appearance  with  true  senile  or  morbid  atrophy. 

It  has  been  stated  that  the  relative  quantity  of  phosphorus  varies  at 
different  periods  of  life,  also  in  healthy  and  diseased  brains;  that  it  is 
small  in  the  infant  and  the  idiot;  but  I  do  not  feel  satisfied  that  this 
assertion  is  established. 

Professor  Ehrenberg  has  shown  that  the  medullary  neurine  actually 
consists  of  very  minute  fibres;  and  he  informs  us  that  these  fibres  can 
only  be  discovered  by  the  aid  of  a  magnifying  power  of  300  diameters, 
and  that  he  was  sometimes  obliged  to  have  recourse  to  a  much  greater 
magnifying  power,  as  800  diameters,  in  order  to  bring  them  into  view. 
He  examined  thin  slices  of  the  recent  brain,  and  states  that  the  fibrous 
structure  was  in  general  most  obvious  at  the  margins  of  the  slices. 
These  fibres  in  the  cineritious  portion  are  interspersed  with  globules 
and  plates  ;  the  greater  number  of 
these  fibres,  instead  of  having  a 
regular  cylindrical  form,  are  knotted 
like  a  string  of  beads,  the  swelled 
portions  being  situated  at  some  dis- 
tance from  one  another,  and  united 
by  narrower  parts  which  are  con- 
tinuous with  them,  and  are  formed 
apparently  of  the  same  material. 

It  is  now  believed  that  this  vari- 
cose appearance  depends  simply  on 
pressure  or  other  force  used  in  pre- 
paring the  objects.  Still  in  some 
portions  of  the  nervous  system  this 
beaded  appearance  is  much  more 
easily  produced  than  in  others,  show- 
ing that  it  depends  on  some  peculi- 
arity of  structure.  It  is  most  easily 
seen  in  those  fibres  which  are  most 
centrally  situated,  and  in  all  proba- 
bility depends  on  the  greater  deli- 
cacy of  the  protecting  portion  of  the 
fibre,  and  also  of  the  investing  mem- 
brane. If  the  fibres  which  compose 
the  fibrous  neurine  are  examined 

With    a    good    micrOSCOpe,    they   will 

be  found  to  have  a  peculiar  and  com- 

plicated     Structure.        TheV     are      not    Tubular  membrane.    B.  Tubular  fibres,    e.    In  a 

1  TJ     /.,  mi  natural  state,  showing  the  parts,  as  in  A.   /.The 

Simply  SOlld    nbrCS.         1  hey    are    per-     white  substance  and  axis  cylinder  interrupted  by 

fpf»f    pvlin<-lp»rc      xrari/i'^nf    i«     rli'orvmfo,.     Pressure;  while  the  tubular  membrane  remains,  g. 
Cylinders,    Varying    in    diameter 

«--*-th    to    ___  ?  __  th    nf   nr.    innVi 
(nn^n      1    looooin  01    an    men. 

average  Width    IS  from  ranrtb 
,  _         i      xi        f  •       i  m,  n 

10  T"0~0"0in  °*    <*n    inch.         A  "ey  are  all 

invested  and  supported  by  a  distinct 
elastic  homogeneous  membrane, 
similar  to  the  sarcolemma  of  the 


A.  Diagram  of  tubular  fibre  of  a  spinal  nerve 


The  same,  with  varicosities.  h.  Various  appear- 
ances  of  the  white  substance  and  axis  cylinder 
forced  out  of  the  tubular  membrane  by  pressure. 

*•  Broken  end  of  a  tubular  fibre,  with  the  white 
substance  closed  over  it.  k.  Lateral  bulging  of 
white  substance  and  axis  cylinder  from  pressure. 


STRUCTURAL   ANATOMY. 


Fig.  2. 


fibres  of  the  voluntary  muscles.  The  neurine  which  is  contained  within 
this  membrane  consists  of  two  portions,  a  central,  which  is  probably  the 
active  portion  of  tubular  neurine,  and  an  outer  or  investing  portion, 
which  possibly  acts  merely  as  an  isolater  of  the  conducting  central  axis. 
The  central  portion  is  called  by  Rosenthal  and  Purkinge,  the  axis  cylinder. 
The  outer  portion  is  the  white  substance  of  Schwann. — (See  fig.  1.) 

The  tubular  membrane  presents  the  same  characters  wherever  it  is 
met  with.  But  the  white  substance  of  Schwann  exhibits  much  variety 
as  regards  its  thickness  in  different  parts  of  the  nervous  system.  In  the 
nerves  it  is  more  developed  than  in  the  centres;  but  even  in  the  former 
it  differs  a  good  deal  as  to  thickness.  We  find  it  most  developed  in 
the  ordinary  spinal  nerves ;  in  those  of  pure  sense  it  exists  in  small 
quantity.  The  chemical  composition  of  the  white  substance,  being 
obviously  different  from  that  of  the  axis,  sufficiently  denotes  a  difference 
of  function  in  these  two  portions  of  the  nerve-tube. 

Stadelmann  describes  the  axis-cy- 
linder of  the  nerve-fibres  as  very  dis- 
tinctly visible  in  transverse  sections  of 
them.  Its  outline  has  commonly  the 
same  form,  and  is  nearly  half  as  large 
as  that  of  the  nerve-fibre  itself;  but 
sometimes  it  looks  as  a  mere  chink 
or  a  central  point.  It  has  been  sug- 
gested, that  the  distinction  of  these 
two  substances  is  merely  the  result  of 
coagulation  or  chemical  agents,  and 
that  it  does  not  exist  in  the  living 
organization ;  but  Dr.  Todd  and  Mr. 
Bowman,  who  have  paid  great  atten- 
tion to  the  microscopic  anatomy  of 
these  parts,  and  from  whom  this  ac- 
count is  derived,  give  the  above  as 
their  deliberate  opinion.* 

There  are  certain  little  bodies,  called 
Pacinian  corpuscles,  which  in  the  hu- 
man subject  are  found  in  great  num- 
bers in  connection  with' the  nerves  of 
the  hand  and  foot.  In  the  mesentery 
of  the  cat,  they  may  be  seen  with  the 
naked  eye,  and  under  the  microscope 
it  exhibits  the  appearance  of  fig.  2, 
taken  from  the  above  work. — (Fig.  75, 
p.  397,  Todd  and  Bowman.) 

The  discoverer  of  the  Pacinian  cor- 
puscles states  that  the  nerve  filament 
has  a  single  contour,  like  the  sympa- 
thetic filaments:  up  to  the  base  of  the 
corpuscle,  the  contour  is  double  ;  at 
its  termination  it  presents  a  granular 


Pacinian  corpuscle,  from  the  mesentery  of  a 
cat.  intended  to  show  the  structure  of  these  bo- 
dies. The  stalk  and  body,  the  outer  and  inner 
system  of  capsules,  with  the  central  cavity,  are 
seen  at  a.  Arterial  twig,  ending  in  capillaries, 
which  form  loops  in  some  of  the  intercapsular 
spaces,  arid  one  penetrates  the  central  capsule. 
b.  The  fibrous  tissue  of  the  stalk,  prolonged 
from  the  rieurilemma.  n.  Nerve-tube,  advanc- 
ing  to  the  central  capsule,  there  losing  its  white 
substance,  and  stretching  along  the  axis  to  the 
opposite  end,  where  it  is  fixed  by  a  tubercular 
enlargement. 


Physiological  Anatomy  of  Man,  1845. 


TUBULAR   NEURINE. 


41 


Fig.  3. 


Ideal  representation  of  the  nerve- 
tube  entering  a  Pacinian  corpuscle,  to 
represent  more  clearly  the  distinction 
between  the  central  axis  and  the  en- 
velope, s  s.  White  substance  of 
Schwann. 


swelling,  like  the  common  ganglion  corpuscle.  Thus  it  will  be  seen 
that  the  central  axis  alone  enters  the  central  capsule.  The  envelope 
having,  as  it  were,  conducted  the  central 
portion  to  the  door,  leaves  it,  and  stops  out- 
side. Thus  we  have,  as  Dr.  Todd  says,  a 
natural  dissection  made  for  us.  This  fact 
renders  his  view  of  the  office  of  the  white 
matter  still  more  likely  to  be  correct. 

Nerve-tubes  never  branch  like  blood- 
vessels, and  never  inosculate  with  one  ano- 
ther ;  though  they  form  loops  at  their  origin 
in  the  nervous  centres,  and  at  their  termi- 
nations. 

Often  as  I  have  traced  these  nerve-tubes 
under  the  microscope,  I  have  never  seen 
them  join  or  anastomose,  as  we  do  the  blood- 
vessels. 

A  nerve-tube  always  performs  one  and 
the  same  office  ;  it  always  conducts  in  the 
same  direction,  and  the  same  kind  of  nervous 
power :  not  at  one  time  carrying  impressions 
which,  on  reaching  the  brain,  become  sensations,  and  at  another  time 
conveying  orders  to  a  muscle  to  contract. 

This  last  position  is  thus  decidedly  asserted,  because  I  feel  not  the 
shadow  of  a  doubt  of  its  correctness ;  and  to  me  it  appears  that  all  the 
important  discoveries  of  Bell  must  be  abandoned,  if  this  be  not  true,  and 
that  we  should  then  be  more  in  the  dark  than  ever  regarding  the  physio- 
logy of  the  brain.  Nevertheless,  this  position  is  actually  disputed  by 
some  anatomists  in  the  present  day. 

In  an  admirable  article  in  the  Medico-Chirurgical  Review  for  July, 
1845,  page  1,  the  writer  of  it  thus  forcibly  combats  such  opinions: — 

"We  certainly  did  not  anticipate,  and  least  of  all  in  England,  that  a 
time  would  arrive  when  it  would  be  necessary  to  vindicate  the  great 
principle  announced  by  Bell,  that  principle  upon  which  all  accurate 
knowledge  of  the  nervous  system  must  ever  repose,  the  individuality, 
namely,  and  uninterrupted  continuity  of  the  primary  nervous  filaments. 
Doubts  have,  however,  been  thrown  upon  this  fundamental  truth,  and 
principally,  as  it  would  appear,  on  the  faith  of  certain  dissections  and 
experiments  of  Stilling,  from  which  it  is  inferred  that  the  elementary 
fibres  interlace  one  with  another  in  the  spinal  cord,  in  the  several  nervous 
plexuses,  and  in  other  parts  of  the  system  ;  that,  in  fact,  the  disposition, 
of  the  nervous  system  is  precisely  analogous  to  what  is  seen  in  the  venous 
and  lymphatic  systems.  We  believe  this  to  be  an  entire  fallacy,  and 
unhesitatingly  express  our  conviction,  resting  on  repeated  and  careful 
examination,  that  no  anatomist  has  ever  seen  in  any  of  the  parts  just 
mentioned,  a  true  anastomosis  in  the  sense  of  that  existing  in  the  vascular 
system.  The  only  places  where  the  primary  nervous  tubules  do  actually 
communicate  is  in  their  peripheral  extremities,  where,  both  in  the  muscles 
and  in  the  tactile  papilla?  of  the  skin,  they  unite  and  form  Iqops.  It  has 
also  been  asserted  by  Valentin,  that  a  similar  disposition  prevails  in  the 


42  STRUCTURAL   ANATOMY. 

central  ends  implanted  in  the  gray  matter  of  the  brain,  but,  as  we  shall 
subsequently  state,  this  must  at  present  be  held  to  be  doubtful 

"  The  functions  of  the  blood-channels  and  nerves  are  so  totally  dif- 
ferent, that  it  is  surprising  any  comparison  between  them  should  have 
been  attempted.  It  is  the  office  of  the  blood-vessels,  not  merely  to  carry 
the  nutritive  fluids  to  all  parts  of  the  body,  but  specially,  by  overcoming 
the  repeated  obstacles  which  impede  the  circulation,  to  secure  in  the 
extreme  divisions  or  capillaries  that  uniform  current  which  alone  is  com- 
patible with  healthy  nutrition.  Now,  how  is  this  to  be  accomplished  ? 
Clearly  by  providing  free  intercommunications  between  all  the  parts  of 
the  vascular  system,  and  more  particularly  between  its  smaller  divisions. 
Thus,  as  to  the  function  of  the  blood-vessels,  it  matters  not  how  the 
blood  reaches  its  destination,  provided  it  does  but  get  there.  But  in  the 
case  of  the  nervous  system,  all  is  reversed  ;  here  the  whole  action  of  in- 
nervation  requires  in  theory  what  is  shown  by  observation,  a  disposition 
of  the  nervous  threads,  which  will  make  them  to  act  as  isolated  conduct- 
ors, so  as  to  transmit  unmingled  the  mandates  of  the  will  centrifugally 
to  special  muscles,  and  centripetally  the  impressions  made  on  the  organs 
of  sense  to  the  brain.  In  consequence  of  the  unsatisfactory  results  of 
many  of  Stilling's  researches,  we  have  again  cautiously  examined  the 
disposition  of  the  primitive  tubes  in  the  spinal  cord,  with  the  express 
object  of  ascertaining  if,  in  any  part  of  the  white  matter  of  the  white 
substance,  anastomosis  could  be  detected.  All  our  examinations  have 
shown  that  the  fibres  invariably  observe  an  isolated  course.  When 
viewed  with  a  sufficiently  high  power,  an  objective  of  one-sixth  of  an 
inch  focus  for  example,  the  beaded  particles  are  beautifully  and  distinctly 
seen  in  a  perfectly  recent  specimen,  and  mixed  with  their  branches  of 
minute  blood-vessels  and  capillaries;  these  latter  canals,  it  is  necessary 
to  state,  present  appearances  so  deceptive,  that  to  an  unpractised  eye, 
and  especially  when  low  powers  are  used,  as  was  done  by  Stilling,  they 
may  very  readily  be  mistaken  for  nervous  tubes,  and  herein,  we  believe, 
will  be  found  the  source  of  the  errors  above  noticed.  The  capillary 
vessels  are  seen  branching  and  uniting,  but  they  present  physical  marks, 
and  especially  nuclei  in  their  walls,  which  are  quite  distinctive  :  indeed, 
we  were  never  more  impressed  with  the  certainty  and  elucidation  which 
microscopic  examination  confers  on  the  great  questions  of  physiology, 
than  by  thus  seeing  under  the  eye  the  true  characteristics  of  the  vascular 
and  nervous  systems. 

u  The  conclusion  at  which  we  have  ourselves  arrived,  as  the  result 
of  direct  inspection,  is  confirmed  by  the  best  observers.  Thus,  Valentin, 
in  his  Physiology,  just  completed,  after  pointing  out  and  demonstrating 
the  physiological  necessity  of  isolated  conductors  in  the  peripheral  portion 
of  the  nervous  system,  both  as  relates  to  sensation  and  motion,  says,  we 
conclude,  as  a  general  anatomical  proposition,  that  all  ramifications, 
anastomoses,  and  interlacements  of  the  nerves,  are  in  reality  only  appa- 
rent, and  therefore  that  no  true  divisions  nor  communications  similar  to 
those  in  blood-vessels  exist,  but  merely  a  corresponding  entrance  or  exit 
of  unbranched,  uninterrupted  primitive  fibrils;  a  disposition  which  enables 
us  easily  to  comprehend  the  laws  of  nervous  conditions." 

Vesicular  or  pulpy  neurine  is  much  more  vascular  than  tubular.  Where 


VESICULAR   OR   PULPY   NEURINE. 


43 


Fig.  4. 


A.  Vesicle  from  the  cineritious  neu- 
rine  of  the  brain  of  a  frog.  B.  Blood 
corpuscle  of  the  same  animal,  to  show 
their  relative  size. 


Fig.  5. 


its  capillaries  are  well  filled  with  injection,  it  appears  under  the  micro- 
scope like  a  minute  network  of  countless  blood-vessels. 

Theneurine,  which  is  deposited  between 
the  meshes  of  this  intricate  mass  of  blood- 
vessels, consists  almost  entirely  of  cells, 
with  nuclei  and  nucleoli,  (see  fig.  4,  A,) 
in  various  stages  of  development.  The 
wall  of  every  vesicle  consists  of  an  ex- 
ceedingly delicate  membrane,  containing  a 
soft  but  tenacious,  finely  granular  mass. 
They  are  mostly  globular,  but  not  uniform- 
ly so.  Some  are  caudate,  and  the  tail  pro- 
longations are  frequently  long.  In  point 
of  structure,  say  Messrs.  Todd  and  Bow- 
man, the  caudate  processes  are  exceedingly  delicate,  and  finely  granular, 
like  the  interior  of  the  vesicle,  with  which  they  distinctly  seem  to  be 
continuous.  Such  is  the  delicacy 
of  these  processes,  that  they  readily 
break  off';  in  general,  very  close  to 
the  vesicle.  Sometimes,  however, 
one  or  more  of  them  may  be  traced 
to  a  considerable  distance,  and  will 
be  found  to  divide  into  two  or  into 
three  branches,  which  undergo  a  fur- 
ther subdivision,  and  give  off  some 
extremely  fine  transparent  fibres  (fig. 
5),  the  connection  of  which  with 
the  other  elements  of  the  nervous 
tissue  has  yet  to  be  ascertained.  It 
is  most  probable,  however,  that 
they  serve  either  to  connect  distant 
vesicles,  or  else  that  they  become 
continuous  with  the  axis  cylinders 
'of  the  tubular  fibres.  In  the  cere- 
bro-spinal  centres,  we  have  found 

the  tissue  in  the  vicinity  of  the  caudate  vesicles  freely  traversed  in  all 
directions  by  numerous  very  delicate  filaments,  which  seem  to  be  the 
ramifications  of  the  caudate  processes.  These  often  exhibit  consider- 
able tenacity  and  elasticity.  The  situations  from  which  we  may  obtain 
such  caudate  vesicles  as  are  best  suited  for  examination,  are  the  "  locus 
niger"  in  the  crus  cerebri,  and  the  gray  matter  of  the  cerebellum  and 
spinal  cord. 

Many  of  these  cells  are  evidently  of  quite  recent  formation  ;  so  much 
so,  that  we  cannot  help  observing  the  analogy  in  the  microscopical  struc- 
ture of  this  portion  of  the  nervous  system  and  the  secreting  portion  of 
the  glandular  system. 

John  Goodsir*  has  thrown  great  light  on  the  part  which  the  nucleated 

*  Anatomical  and  Pathological  Observations,  by  John  Goodsir  and  Harry  Goodsir,  1845, 
.page  7. 


(Todd  and  Bowman,  p.  212.)  Nerve  vesicles 
from  the  Gasserian  ganglion  of  the  human  sub- 
ject, a.  Globular  one  with  a  defined  border,  b. 
Its  nucleus,  c.  Its  nucleolus.  d.  Caudate  vesicle. 
e.  Elongated  vesicle,  with  two  groups  of  pigment 
particles,  f.  Vesicles  surrounded  by  its  sheath, 


or  capsule,  of  nucleated  particles, 
the  thread  only  being  in  focus, 
diameters. 


;The  same, 
agnified  300 


44  STRUCTURAL    ANATOMY. 

cell  plays  in  the  secreting  process.  It  has  been  already  stated,  upon 
other  grounds  than  those  now  to  be  advanced,  that  the  cineritious  sub- 
stance of  the  brain  stands  in  the  same  relation  to  the  nerves  that  the  se- 
creting portion  of  a  gland  does  to  its  duct.  This  theory  appears  to  me 
now  most  curiously  confirmed  by  the  structure  and  functions  of  the  in- 
testinal villi. 

To  understand  the  part  which  the  vesicles  of  the  villus  play  in  diges- 
tion, it  is  necessary  to  be  aware  of  certain  of  the  functions  of  the  cell 
with  which  physiologists  are  yet  unacquainted. 

Not  only  are  these  bodies  the  germs  of  all  tissues,  as  determined  by 
the  labors  of  Schleiden  and  Schwann,  but  they  are  also  the  immediate 
agents  of  secretion.  A  primitive  cell  absorbs  from  the  blood  in  the 
capillaries,  the  matters  necessary  to  form,  in  one  set  of  instances,  nerve, 
muscle,  bone,  if  nutrition  be  its  functions ;  milk,  bile,  urine,  in  another 
set  of  instances,  if  secretion  be  the  duty  assigned  to  it.  The  only  dif- 
ference between  the  two  functions  being,  that  in  the  first,  the  cell  dis- 
solves and  disappears  among  the  textures,  after  having  performed  its 
part ;  in  the  other  it  dissolves,  disappears,  and  throws  out  its  contents 
on  a  free  surface. 

In  another  place,  he  says,*  "The  ultimate  secreting  structure,  then,  is 
the  primitive  cell  endowed  with  a  peculiar  organic  agency,  according  to 
the  secretion  it  is  destined  to  produce." 

The  observations  of  Henle,  quoted  by  that  admirable  physiologist,  Dr. 
Carpenter,  regarding  the  difference  in  the  structure  of  the  cortical  sub- 
stance of  the  brain,  (the  hemispherical  ganglion,}  all  support  this  view. 
On  the  surface  of  the  brain,  that  is,  the  portion  of  the  ganglion  which  is 
nearest  to  the  vascular  network,  the  ganglion  vesicles  seem  to  be  imper- 
fectly formed.  There  is  a  finely  granular  substance  containing  spherical 
or  oval  vesicles,  with  one  or  two  dark  granules  in  them.  In  a  rather 
deeper  layer  these  vesicles,  instead  of  being  irregularly  scattered  through 
the  granular  substance,  seem  to  have  appropriated  each  to  itself  a  portion 
of  the  latter  for  an  independent  covering;  and  from  this  condition  there 
seems  to  be  a  regular  gradation,  till,  in  the  yet  deeper  layers  of  the  cor- 
tical substance,  the  vesicles,  with  their  granular  coverings,  are  replaced 
by  perfect  ganglion-like  globules  with  their  filamentous  sheaths. 

It  is,  then,  most  probable  that  the  nucleated  cells  of  vesicular  neurine 
are  the  active  agents  in  the  production  of  nervous  power;  that  they  are 
developed,  and  perform  their  office,  in  the  same  way  as  the  nucleated 
cells. 

The  enormous  quantity  of  blood  which  the  vesicular  neurine  receives, 
affords  strong  evidence  that  this  structure,  like  the  acknowledged  secret- 
ing organs,  employs  that  blood  in  the  preparation  of  a  something.  In- 
deed, the  effect  of  arresting  the  cerebral  circulation  shows  most  clearly 
that  all  the  mental  operations  are  dependent  on  the  flow  of  blood  through 
the  brain,  for  their  production.  The  experiments  of  Sir  Astley  Cooper 
on  the  rabbit  are  most  interesting  and  satisfactory. 

We  have  seen  that  neurine  contains  about  one  per  cent,  of  phosphorus. 
The  excessive  excretion  of  phosphorus  with  the  urine,  after  severe  mental 

*  P.  25,  kc.  dt. 


VESICULAR   NEURINE.  45 

exertion — a  fact  first  pointed  out  by  Dr.  Prout — may  be  cited  as  support- 
ing this  view  of  the  analogy  between  the  production  of  nervous  power 
and  ordinary  secretion. 

Dr.  Golding  Bird,  in  his  excellent  little  work  on  urinary  deposits,  gives 
a  very  striking  case,  illustrative  of  this  connection.* 

"  Where  the  presence  of  the  triple  phosphate  is  only  occasional,  its 
connection  may  be  traced  with  some  cause  which  has  rendered  the  system 
morbidly  irritable,  at  the  same  time  that  its  tone  or  vigor  has  become 
depressed.  The  simplest  examples  of  this  kind  that  have  occurred  to 
me,  have  been  in  cases  of  individuals  of  nervous  temperament,  who 
have  periodical  duties  to  perform,  requiring  so  much  mental  tension  and 
bodily  exertion.  I  have  witnessed  this  state  of  things  several  times  in 
clergymen,  especially  in  those  who,  from  the  nature  of  their  secular 
engagements,  have  been  compelled  to  lead  sedentary  lives-  during  the 
week,  and  to  perform  full  duties  on  Sundays;  the  best  illustration  of  this 
I  ever  met  with,  was  in  the  person  of  a  well-known  and  deservedly 
popular  clergyman,  who,  from  his  connection  with  a  public  school, 
scarcely  used  any  exercise  during  the  week,  whilst  on  Sunday  he  per- 
formed duty  thrice  in  church.  This  gentleman  was  a  tall  thin  person, 
of  dark  complexion,  lustrous  eyes,  and  almost  phthisical  aspect.  He 
was  the  subject  of  constant  dyspepsia.  The  urine  passed  on  Saturday 
evening,  as  well  as  on  Sunday  morning,  though  repeatedly  examined, 
was  healthy,  except  in  depositing  urate  of  ammonia,  and  being  of  high 
specific  gravity.  Before  his  Sunday  duties  were  completed,  he  almost 
invariably  became  the  subject  of  complete  fatigue,  with  a  painful  aching 
sensation  across  the  loins,  in  addition  to  the  flatulence  and  epigastric 
uneasiness  under  which  he  always  labored.  The  urine  voided  before 
retiring  to  rest  after  the  severe  exertions  of  the  day,  was  almost  con- 
stantly of  a  deep  amber  hue,  high  specific  gravity,  and  deposited  the 
triple  phosphate  in  abundance.  The  urine  of  Monday  would  contain 
less  of  this  salt,  which  generally  disappeared  on  the  following  day,  and 
once  more  reappeared  on  the  Sunday  evening.  I  had  an  opportunity  of 
observing  this  state  of  things  for  several  weeks,  and  it  ultimately  disap- 
peared by  the  patient  relaxing  from  his  duties  and  enjoying  the  amuse- 
ment of  traveling  for  a  few  weeks." 

I  have  been  frequently  consulted  by  a  gentleman  in  business,  of  a 
highly  nervous  temperament  and  excitable  brain,  on  account  of  a  depo- 
sit of  phosphorus  in  his  urine.  In  the  morning  this  excretion  is  per- 
fectly clear  and  healthy,  but  after  he  has  been  harassed  by  business,  it 
then  becomes  cloudy.  If,  however,  he  is  in  the  country,  and  free  from 
anxiety  of  any  kind,  the  water  is  then  bright  and  natural.  "  Many  cir- 
cumstances," says  Dr.  Carpenter,  ulead  to  the  belief,  that  the  nervous 
tissue,  when  in  a  state  of  functional  activity,  undergoes  a  rapid  waste  or 
disintegration,  and  a  corresponding  renewal." 

My  readers  must  not  conclude  from  the  above  observations,  that  I 
consider  mind  to  be  dependent  on  matter.  I  believe  that  matter  is 
merely  the  instrument  which  the  mind  employs,  and  I  quite  agree  with 
my  friend  from  whom  I  have  last  quoted,  where  he  says,  p.  83,  "When 

•  Urinary  Deposits,  &c.,  by  Golding  Bird,  M.  D.    1844. 


46  STRUCTURAL    ANATOMY. 

we  speak  of  sensation,  thought,  emotion,  or  volition,  therefore,  as  func- 
tions of  the  nervous  system,  we  mean  only  that  this  system  furnishes  the 
conditions  under  which  they  take  place  in  the  living  body." 

The  gelatinous  nerve  fibre  was  first  described  by  Henle  :  it  is  flattened, 
soft,  and  homogeneous  in  appearance;  containing  numerous  cell-nuclei, 
some  of  which  are  round,  others  oval ;  some  situated  in  the  centre  of 
the  fibre,  others  adhering  to  either  edge,  their  longest  diameter  being 
generally  parallel  to  the  longitudinal  axis  of  the  nerve.  These  nuclei 
are  arranged  at  nearly  equal  distances,  and  frequently  exhibit  distinct 
nucleoli.  Sometimes  these  fibres  show  a  disposition  to  split  into  very 
delicate  fibrillaB.  Acetic  acid  dissolves  the  fibre,  leaving  the  nuclei  un- 
changed. These  fibres,  containing  nothing  analogous  to  the  white  sub- 
stance of  Schwann,  are  devoid  of  that  whiteness  which  characterizes 
the  tubular  fibre  ;  and  it  would  seem  that  the  gray  color  of  certain 
nerves  depends  chiefly  upon  the  presence  of  a  large  proportion  of  the 
gelatinous  fibres;  hence  they  are  sometimes  called  "  gray  fibres." 

The  mode  of  connection  of  the  gelatinous  fibres  with  the  elements  of 
the  nervous  centres  is,  as  yet,  quite  unknown.  They  are  found  in  con- 
siderable numbers,  in  what  are  called  the  roots  of  the  sympathetic,  or 
the  communications  of  that  nerve  with  the  spinal  nerves ;  it  has  been 
supposed  by  Valentin  that  they  are  continuous  with  certain  elements  of 
the  vesicular  nervous  matter. 

These  fibres  are  smaller  in  general  than  the  tubular  fibres ;  their 
diameter  ranges  between  the  eoV^th  and  the  ^oWth  of  an  inch.  They 
resemble  very  much  the  fibre  of  unstriped  muscle. 

When  I  first  read  the  description  of  this  fibre,  I  confess  I  thought  it 
improbable.  We  can  understand  the  existence  of  one  kind  of  neurine, 
for  the  production  of  power,  and  another  for  the  conduction  of  it.  But 
I  could  never  quite  understand  why  there  should  be  a  different  kind  for 
the  sympathetic  nerve,  and  cerebro-spinal  system,  when  it  is  clear  that 
the  same  kind  of  vesicular  or  cineritious  neurine  performs  twenty  offices 
in  different  situations — for  instance,  in  the  spinal  cord  and  in  the  brain ; 
yet  the  microscope  detects  no  difference  of  structure.  It  did,  therefore, 
appear  to  me  contrary  to  that  beautiful  simplicity  which  reigns  through- 
out the  animal  organism. 

Mr.  Paget,  in  those  admirable  reports  on  physiology  which  are  pub- 
lished in  the  British  and  Foreign  Quarterly  Medical  Review,  gives  an 
excellent  summary  of  the  state  of  the  discussion  at  present  (July,  1846). 

"Bidder  and  Volkmann,  on  the  one  hand,  have  maintained  that 
there  exists  in  the  sympathetic  nerve  a  set  of  nerve-fibres,  characterized 
by  their  fineness,  (they  being  only  about  half  or  one-third  as  large  as 
the  cerebro-spinal  fibres,)  their  paleness,  the  absence  of  a  double  contour, 
their  nearly  uniform  contents,  and  their  yellowish  gray  color  when  in 
bundles  ;  Valentin  holding  that  the  sympathetic  fibres  are  neither  in 
structure  nor  in  relations  peculiar." 

"The  most  important  contribution,"  says  Mr.  Paget,  "to  the  phy- 
siology of  the  nervous  system  this  year  (1846),  is  from  Kolliker.* 

*  Die  Selbstiindigkeit  und  Abkangigkeit  des  sympathischen  Nerven-system.  Zurich, 
1844,  4to. 


VESICULAR   NEURINE.  47 

uln  the  discussion  of  the  question,  Kolliker  states,  1st,  that  the  fibres 
described  by  Remak  as  peculiar  to  the  sympathetic  nerve,  and  which 
are  commonly  called  Remak  fibres,  are,  as  Valentin  has  always  held, 
not  nerve  fibres  at  all,  but  Neurilemma,  consisting  of  imperfectly  deve- 
loped fibro-cellular  bundles;  2d,  he  determines  that  Bidder  and  Volk- 
mann  are  right  in  their  description  of  the  structure  of  fine  nerve-fibres, 
or  at  least  of  the  well-marked  examples  of  them,  and  that  these  are  not 
(as  Valentin  maintained  that  they  were)  Remak  fibres.  But  he  denies 
that  these  fine  nerve-fibres  are  peculiar  to  the  sympathetic  system,  or 
even  so  different  from  the  common  larger  cerebro-spinal  nerve-fibres, 
that  they  ought  to  be  regarded  as  of  a  kind  distinct  from  them.  To 
justify  this  denial,  he  shows  that  the  characters  assigned  to  these  fine 
nerve-fibres,  as  distinctive  by  Bidder  and  Volkmann,  are  neither  defi- 
nitely marked,  nor  constant,  nor  essential;  that  there  is  no  real  differ- 
ence between  these  fine  fibres  and  those  of  the  brain,  spinal  cord,  and 
nerves  of  special  sense;  that  commonly  the  larger  fibres  assume  near 
their  peripheral  end  the  size  and  other  characters  of  the  smaller  ones  ; 
and  that  many  fine  fibres  are  found  in  all  nerves,  though  it  is  generally 
true  that  there  is  a  smaller  proportion  of  them  in  the  cerebro-spinal  than 
in  the  sympathetic  nerves. 

"  But,  although  it  thus  appears  to  be  an  error  to  speak  of  sympathetic 
and  cerebro-spinal  nerve-fibres  as  if  they  were  two  different  kinds  of 
fibres,  yet  the  differences  which  do  exist  between  them,  and  the  various 
proportions  in  which  the  fine  fibres  occur,  in  different  nerves,  make  it 
important  to  discern  their  origin  and  course.  On  these  points,  Kolliker 
first  proves  that  these  fine  fibres  have  their  origin,  not  only  in  ganglionic 
or  nerve  corpuscles  of  the  sympathetic  ganglia,  but  in  those,  also,  of  the 
ganglia  on  the  cerebral  and  spinal  nerves,  and  in  the  corpuscles  of  the 
brain  and  spinal  cord.  In  this,  his  observations  fully  confirm  those  of 
Helmhotz,  Will,  and  Hannover,*  who,  like  him,  have  seen  this  mode 
of  origin ;  and  from  Bidder  and  Volkmann,  who,  from  another  mode  of 
investigation,  concluded  that  fine  fibres  must  thus  arise.  Kolliker  has 
seen  this  mode  of  origin  of  nerve-fibres  in  the  spinal  cord,  and  in  the 
spinal  and  sympathetic  ganglia  of  the  frog,  in  the  spinal  ganglia  of  the 
tortoise  and  cat,  and  in  the  Gasserian  ganglion  of  the  cat  and  guinea- 
pig.  Hannover  has  found  it  in  all  classes  of  Vertebrata,  and  in  many 
Invertebrata,  in  the  brain  and  spinal  cord,  and  in  all  kinds  of  ganglia  ; 
neither  has  he  observed  any^  other  mode  of  origin  besides  this.  The 
description  given  by  Kolliker,  of  the  spinal  ganglia  of  the  frog,  is,  that 
they  contain  one  form  of  ganglion  or  nerve  corpuscles,  which  are  of 
simple  shape,  and  give  off  no  processes,  and  many  other  corpuscles,  more 
or  less  pyriform,  which,,  at  their  smaller  end,  are  drawn  out  into  a  pro- 
cess. This  process,  like  the  corpuscles,  is  pale,  and  finely  granular;  it 
is  from  fo^Wh  to  Tffo^h  of  an  inch  in  diameter,  and,  after  proceeding 
about  j-^th  of  an  inch,  it  rather  suddenly  acquires  a  dark  contour  and 
slightly  granular  contents:  it  is,  in  short,  becoming  a  fine  nerve-fibre. 
And  in  regard  to  those  cases  in  which  he  has  not  seen  this  mode  of  origin 
of  the  fine  fibres,  Kolliker  so  far  confirms  or  admits  the  truth  of  Bidder 

*  Recherches  Microse  sur  le  systeme  Nerveux  ;  Copenhague,  1844,  4to. 


48  STRUCTURAL   ANATOMY. 

and  Volkraann,  respecting  the  relative  number  of  fine  fibres,  which  enter 
and  leave  the  ganglia,  that  he  considers  it  proved  that  a  great  number  of 
these  fibres  have  their  origin  in  the  ophthalmic  ganglion,  and  in  the  gan- 
glion of  the  vagus  of  fish,  and  considers  it  as  highly  probable  that  the 
ganglia  of  the  cerebral  and  spinal  nerves  of  all  the  higher  animals  are 
also  sources  for  similar  fibres.* 

"  As  to  the  relative  proportions  of  large  and  fine  fibres  in  the  nerves, 
distributed  to  various  parts,  Kolliker  concludes,  from  his  own  and  other 
observations,  that — 1st,  The  nerves  of  voluntary  muscles  contain  in  their 
trunks  a  majority  of  large  fibres,  but  in  their  peripheral  distribution  either 
only,  or  a  majority  of,  fine  fibres.  2d.  The  nerves  of  the  skin  contain 
(for  the  most  part)  equal  numbers  of  both;  but,  in  some  of  them,  one  or 
other  size  of  fibres  greatly  preponderates,  and,  in  all  of  them,  the  fine 
fibres  greatly  preponderate  in  their  peripheral  distribution.  3d.  The 
nerves  of  sensitive  mucous  membrane  are,  in  this  respect,  like  those  of 
the  skin,  except  that  in  the  nerves  of  the  teeth,  pulps,  and  the  gums, 
there  is  a  great  majority  of  large  fibres.  4th.  In  the  nerves  of  involun- 
tary muscles,  and  of  the  less  sensitive  or  insensible  mucous  membranes, 
there  is  a  great  preponderance  of  fine  fibres. "f 

From  the  above  facts,  it  may  be  concluded  that  nerve-fibres  of  the 
sympathetic  nerve  differ  from  those  of  cerebro-spinal,  in  the  absence  of 
the  white  substance  of  Schwann ;  and  this  substance  is  found  where  the 
nerve  is  more  exposed  to  pressure,  or  any  kind  of  injury,  from  external 
causes.  When  the  filaments  of  the  cerebro-spinal  have  nearly  reached 
their  destination,  then  they  cease  to  require  the  protecting  material  which 
was  necessary  in  their  course  down  a  limb,  and  between  the  bodies  of 
the  muscles.  The  sympathetic  nerve  is  generally  deep-seated  and  well 
protected,  and  hence  the  absence  of  this  protecting  matter.  We  can 
easily  understand  what  contrivance  must  be  necessary  to  protect  the  deli- 
cate neurine  when  it  has  to  travel,  like  the  sciatic  nerve,  for  instance, 
from  the  pelvis  to  the  toes.  Physically,  it  appears  almost  as  strong  as  a 
tendon,  and  it  had  need  to  be  so,  exposed,  as  it  is,  in  all  the  movements 
of  the  limb. 

Its  physical  strength,  then,  and  its  power  of  resisting  injury,  are  due  to 
its  investing  membrane,  and  the  presence  of  the  matter  of  Schwann; 
while  the  essential  portion  of  the  nerve,  that  in  which  its  vital  powers 
reside,  is  the  axis  cylinder. 

We  all  know,  that  even  with  all  this  bountiful  provision,  the  nerves 
may  be  easily  compressed  so  as  temporarily  to  suspend  their  function.  If 
we  only  fall  asleep  with  one  leg  crossed  over  the  knee  of  the  other,  so 
as  to  compress  the  popliteal  nerve,  when  we  awake  we  find  our  leg  numb 
and  powerless,  until  we  have  suffered  all  the  pain  of  the  feeling  com- 
monly called  pins  and  needles,  or  live  blood,  as  the  nerve-fibres  recover 
their  power,  and  the  nervous  current  is  re-established. 

*  The  most  striking  instance  in  which  more  fibres  leave  than  enter  the  ganglia,  is  seen 
in  the  septum  of  the  auricles  of  a  frog's  heart,  which  is  so  transparent  that  the  ganglia  and 
nerve-fibres  may  be  counted  in  it.  Here  Bidder  has  often  seen  more  fibres  in  one  than  in 
the  other  two  branches  from  a  ganglion ;  e.  g.  five  in  one,  seven  in  the  other.  Volkmann, 
in  Art.  Nerven  Physiologic,  /.  c. 

f  British  and  Foreign  Quarterly  Medical  Review,  p.  273. 


GELATINOUS    FIBRE. 


49 


Sometimes  when  you  are  examining  the  nerve-tubes  under  the  micro- 
scope, from  the    spinal 

cord  of  the  frog,  you  will  Fie-  6-  Fis-  7- 

see  the  two  kinds  of 
tubes  most  distinct.  The 
accompanying  figure  re- 
presents two  of  the  gela- 
tinous fibres,  one  twisted 
round  the  other.  They 
were  exactly  the  size  of 
the  axis  cylinder  of  the 
ordinary  fibres,  as  seen 
in  the  same  field.  This 
sketch  was  taken  with 
Dr.  Carpenter,  through 
whose  glass  I  observed 
them.— (Fig.  6.) 

The  nervous  centres, 
or  ganglion,  consist  of 
the  vesicular  neurine 
traversed  by  the  tubular  neurine. — (See  Fig.  7.)  This  represents  very 
well  the  appearance  exhibited  by  a  ganglion  or  nervous  centre.  Let  it 
then  be  remembered  that  vesicular  neurine  does  not  exist  in  the  nerves, 
and  that,  when  these  cords  present  a  grayish  appearance,  as  in  the  sym- 
pathetic, it  is  owing  to  the  deficiency  of  the  white  substance  of  Schwann. 


Gelatinous  nerve- 
fibres  in  the  frog. 


(Todd  and  Bowman,  after  Valentin.)  — A 
small  piece  of  the  otic  ganglion  of  the  sheep, 
slightly  compressed ;  showing  the  interlace- 
ment of  the  internal  fibres  and  the  vesicular 
matter. 


50 


PART  II. 

COMPARATIVE  ANATOMY. 

THE  naturalist  who  devotes  his  time  to  observing  the  habits  and 
instincts  of  animals,  their  external  form  and  general  appearance,  pursues 
a  branch  of  science  which  has  unfolded  a  multitude  of  facts  highly  inte- 
resting and  amusing  to  him  who  delights  in  the  works  of  nature.  But 
the  physiologist  follows  in  his  pursuit  of  knowledge  a  more  arduous  and 
elevated  path;  for,  not  satisfied  with  observing  the  manners,  actions  and 
outward  appearance  of  animals,  he  carries  forward  his  researches  to 
their  internal  organism,  with  the  view  of  ascertaining  the  relation  which 
structure  bears  to  function. 

Researches  of  this  kind  afford  us  the  most  important  and  valuable 
proofs  which  we  possess,  of  the  office  of  a  nervous  system  in  the  execu- 
tion of  those  acts  which  are  exhibited  to  us  by  living  beings.  By  such 
investigations  the  physiologist,  discovering  that  the  development  of  their 
internal  organs  corresponds  with  an  increased  capacity  of  enjoyment,  the 
existence  of  which  is  demonstrated  by  their  habits  and  instincts,  obtains 
the  only  evidence  which  a  science  of  observation  like  physiology  is  capa- 
ble of  affording,  that  they  stand  in  the  relation  of  cause  and  effect. 

On  this  principle,  I  consider  that  the  study  of  the  anatomy  and  phy- 
siology of  the  human  brain  could  not  be  introduced  to  the  student  in  a 
more  philosophical  manner,  or  with  a  prospect  of  greater  advantage  to 
himself,  than  by  taking  an  extended  but  general  view  of  the  nervous 
system  of  the  lower  orders  of  animals.  I  shall  not  enter  with  much 
detail  into  the  immense  variety  of  forms  which  the  study  of  the  nervous 
system  of  the  whole  animal  kingdom  presents  to  us,  because  I  merely 
wish  to  use  comparative  anatomy  as  an  ally  in  my  attempt  to  simplify 
the  study  of  the  human  brain,  without  regarding  it,  as  it  really  is,  as  an 
object  of  extreme  interest,  independent  of  the  service  which  it  thus  is 
capable  of  rendering  to  the  student  in  medicine. 

The  celebrated  Haller,  who  thoroughly  felt  the  value  of  comparative 
anatomy  in  the  study  of  human  physiology,  and  the  importance  of  taking 
this  course,  when  reasoning  on  the  functions  of  a  nervous  system,  after 
observing  that  a  brain  and  medulla  spinalis  are  met  with  in  animals 
with  a  head  and  with  eyes,  says,  "  Neque  credo  aut  oculos  absque  cere- 
bro,  aut  absque  oculis  cerebrum  in  ullo  animale  reperiri.  Sunt  ergo  sua 
cerebra  vermibus,  mytulis,"  &c. 

All  physiologists  of  the  present  day  agree  in  considering  the  nervous 
system  as  the  medium  by  which  animals  are  connected  with  the  external 
world.  Apd  when,  in  our  dissection  of  some  of  the  inferior  orders  of 


DIVISIONS   OF    THE   ANIMAL    KINGDOM.  51 

animals  in  whom  there  is  an  evident  susceptibility  to  receive  impres- 
sions from  external  nature,  and  to  react  upon  those  impressions,  we  are 
unable  to  demonstrate  the  existence  of  a  nervous  system,  we  come  to 
the  conclusion  that  the  sentient  matter  which  we  call  neurine  is  not  ab- 
sent, but  developed  in  such  minute  quantity  and  so  transparent  that  it 
escapes  our  observation. 

The  presence  of  a  nervous  system  is  not  necessarily  a  proof  of  con- 
sciousness on  the  part  of  the  animal  in  whom  it  is  found.  The  invaluable 
and  philosophic  researches  of  Dr.  Marshall  Hall  have  quite  established 
this  most  important  fact,  that  all  the  actions  which  take  place  in  man 
and  animals  in  general,  independent  of  volition,  are  as  much  excited 
and  guided  by  the  nervous  power  as  those  which  are  directed  by  the 
will.  For  instance,  all  the  complicated  acts  of  swallowing  are  as  much 
dependent  on  the  nervous  system  as  the  act  of  raising  the  food  to  our 
mouths.  These  important  discoveries  of  Dr.  Hall  will  of  course  be  more 
fully  considered  in  relation  to  the^cerebro-spinal  system  of  man ;  but  I 
cannot  mention  his  name  without  expressing  the  regret  I  feel,  that  the 
most  important  contribution  to  physical  science,  since  the  discovery  of 
Bell,  should  have  been  passed  by  unnoticed  and  unknown  by  that  scien- 
tific society,  whose  object  is  to  promote  science  and  reward  real  merit. 
These  researches  of  Dr.  Hall  have  been  rendered  still  more  valuable  by 
those  of  Mr.  Grainger,  Dr.  Carpenter,  Mr.  Newport,  and  others,  who 
have  shown  that  one  of  the  most  important  functions  of  a  nervous  sys- 
tem, as  regards  the  vital  existence  of  an  animal,  is  to  receive  impres- 
sions, and  to  react  on  such  impressions,  independent  of  the  consciousness 
or  the  will  of  the  individual.  This  fact  will  be  found  universal  in  its 
application.  Wherever  the  wants  of  an  animal  require  a  consent  in  the 
action  of  its  organs,  such  actions  are  called  into  play,  and  superintended 
and  controlled  by  a  nervous  system.  If  we  examine  the  organization  of 
the  simplest  animals,  we  find  that  it  consists  of  little  more  than  a  sto- 
mach for  digesting  food,  and  arms  for  the  collection  of  it.  There  must, 
however,  be  a  consent  between  these  organs  of  digestion  and  collection, 
and  we  find  in  them  a  nervous  system  to  effect  it.  As  we  ascend  in  the 
animal  kingdom,  we  find  other  organs  added  to  those  of  mere  digestion 
and  collection,  or  prehension,  and  with  them  a  more  complicated  nerv- 
ous system ;  so  that,  in  fact,  the  size  and  complexity  of  the  nervous  sys- 
tem are  a  good  criterion  of  the  endowments  of  the  animal,  and  its  relative 
position  in  the  scale  of  animated  existence.  And  the  nervous  system  is 
now  universally  allowed  to  afford  the  best  principle  for  the  classification 
of  animals.  The  animal  kingdom  has  been  divided  into  five  grand  di- 
visions, or  sub-kingdoms,  and  named  in  accordance  with  the  form  arid 
arrangement  of  the  nervous  system. 

1st.  The  Cryptoneura  of  Rudolphi,  or  the  Acrita  of  MacLeay. 

2d.  The  Nematorieura  of  Owen,  Cycloneurose  of  Grant,  Radiata 
of  Cuvier. 

3d.  Homo-Gangliata  of  Owen,  Diploneurose  of  Grant,  Articulata  of 
Cuvier. 

4th.  Hetero-Gangliata  of  Owen,  Cyclo-Gangliata  of  Grant,  Mollusca 
of  Cuvier. 

5th.  Myelencephala  of  Owen,  Spini-cerebrata  of  Grant,  Vertebra t'a 
of  Cuvier.  >**' 


52 


COMPARATIVE   ANATOMY. 


Fig.  8. 


In  the  first  of  these  divisions  the  nervous  system  is  indiscernible,  and 
neurine,  if  existing  at  all,  is  so  minute  in  quantity,  and  so  transparent, 
that  it  cannot  be  demonstrated  as  forming  a  separate  system.  In  the 
second,  the  Nematoneura,  the  ganglia  are  so  extremely  minute  that  the 
•whole  presents  a  mere  thread-like  appearance.  But  the  term  is  applica- 
ble only  as  designating  the  appearance,  and  not  the  actual  structure ;  for 
in  these  animals,  Ganglia,  Commissures,  and  Nerves,  the  three  element- 
ary portions  of  every  nervous  system,  though  scarcely  visible,  exist  as 
perfectly  formed  as  in  the  highest  animals.  Thirdly.  In  the  Homo- 
Gangliata  the  ganglia  are  generally  of  nearly  equal 
size;  none  decidedly  exceeding  any  of  the  rest. 
Fourthly.  The  Hetero-Gangliata  are  so  named 
from  the  singular  manner  in  which  the  ganglia 
are  scattered  through  the  body.  Fifthly.  The 
Myelencephala  include  all  animals  with  a  perfect 
brain  and  spinal  cord. 

It  will  generally  be  found  that  the  Nematoneura 
are  the  most  simple  ;  the  Homo-Gangliata  the  next, 
and  so  on.  But  this  is  not  uniformly  the  case; 
for  the  nervous  system,  to  which,  as  being  the 
most  simple,  it  will  be  desirable  first  to  direct  our 
attention,  is  taken  from  the  Homo-Gangliate  divi- 
sion. But  it  is  not  improbable  that  the  simplicity 
in  this  instance  arises  solely  from  its  being  imper- 
fectly developed  or  in  a  rudimentary  state,  and 
may  perhaps,  therefore,  be  considered  as  affording 
an  imperfect  type  of  a  nervous  system. 

As  my  present  object,  in  alluding  to  the  nerv- 
ous organization  of  the  lower  orders,  is  not,  as  I 
have  said,  to  carry  my  readers  minutely  into  the 
subject,  but  solely  to  make  the  study  of  the  human 
brain  more  simple  and  interesting,  I  shall  confine 
myself  to  the  description  of  the  most  prominent 
features  in  each  division. 

The  most  simple  form  in  which  we  find  the  nerv- 
ous matter  arranged  so  completely  as  to  constitute 
a  distinct  nervous  system  is  in  the  Ascaris,  a  spe- 
cies of  intestinal  worm  ;  we  can  scarcely  conceive 
an  animal  having  its  relations  to  the  external  world 
more  limited  than  this;  it  has  not  even  to  seek  its 
food  beyond  the  narrow  spot  to  which  its  existence 
is  confined,  and  can  therefore  have  little  necessity 
Mouth  surrounded  by  three  fQr  a  nervous  system,  and  we  find  it  accordingly 

tubercles,    b.    The   anus.    r.  t  J  '  CT  J 

Contracted  portion  found  at    but  imperfectly   developed.      Jules   Cloquet    has 

the    union    of* the    anterior         .  ,       «*  /.   .» 

third  of  the  body,  with  the     given  us  the  best  account  of  the  nervous  system 
two  posterior  thirds%T  i.Ab-  animals:  it  is  from  a  work  published  by 


1*  Female  Ascaris  seen  on 
its    abdominal    surface 


dominal  nerve.    2.  Vulva. 


2*  An  enlarged  view  of    him  on  this  subject,  in  1824,  that  the  following 

Two  white 


a  transverse  section  of  the  -     . 

•game  worm.  A.  The  skin,    account  and  drawing  were  derived. 


'"Dorsal    nerve, 
nal  nerve. 


2.  Abdomi- 


i.    cords,  rather  thicker  in  the  middle  of  the  body 
t^e  extremities,  composed  of  a  series  of 


ASCARIS.— ASTERIAS, 


Fig.  9. 


small  lines  united  at  angles,  or,  as  it  were,  broken  and  slightly  swollen 
at  each  angle,  sending  to  the  right  and  left  filaments  so  thin  that  they 
escape  the  eye,  except  when  seen  through  a  magnifying  lens,  constitute 
their  nervous  system.  These  cords  are  situated  within  the  plane  of  the 
muscular  fibres,  and  descend,  the  one  on  the  abdominal,  the  other  on 
the  dorsal,  surface  of  the  alimentary  canal.  The  abdominal  nerve  forms 
a  circle  around  the  vulva  of  the  female,  as  will  be  seen  by  reference  to 
the  diagram ;  the  slight  enlargements  Cloquet  regards  as  ganglionic. 

Laennec,  Otto,  Lamarck  and  Cuvier  all  agree  with  Cloquet  in  con- 
sidering the  lines  above  described  as  the  nervous  system.  Nevertheless 
it  appears  to  me  extremely  probable  that  these  cords  do  not  represent  a 
perfect  type  of  a  nervous  system,  even  in  its  most  simple  form,  but  that 
in  this  individual  it  has  been  arrested  in  its  development 
at  a  period  corresponding  to  one  of  the  regular  stages 
through  which  the  nervous  system  passes  in  the  higher  or- 
ders, in  whom  we  know  that  the  nerves  are  developed  first, 
and  the  centres  or  ganglia  afterwards  ;  and  in  this  animal, 
where  the  ganglia  scarcely  exist,  is  it  not  possible  that  the 
organization  is  incomplete;  that  the  animal,  in  fact,  is  not 
perfect;  that  the  conducting  portion  of  the  nervous  appara- 
tus has  been  formed,  but  not  the  point  from  which  the 
power  emanates,  requiring  to  be  conducted  ? 

The  above  simple  arrangement  perfectly  corresponds  with 
the  first  appearance  of  the  cerebro-spinal  axis  during  deve- 
lopment of  the   vertebrated  class  of  animals,  and  affords  a 
beautiful  illustration  of  the   law,  that  the  higher  classes  of 
animals,  during  their  development,  go  through  some  of  those  forms  which 
are  permanently  retained  by  the  lower 
orders.  About  the  twenty-fourth  hour 
after  incubation  has  commenced  in 
the  egg  of  the  common  fowl,  the  ru- 
diment of  the   spinal  cord   may  be 
seen  in  the  form  of  two  white  lines 
(see  fig.  9),  perfectly  similar  in  ap- 
pearance to  the  nervous  cord  in  the 
Ascaris. 

Let  us  next  direct  our  attention  to 
the  nervous  system  of  one  of  the 
Asterias  ;  it  is  beautifully  simple,  and 
not  the  less  instructive  ;  for  whether 
we  regard  the  motions  of  this  animal 
as  the  result  of  volition  or  not,  they 
are  evidently  regulated,  and  not  ac- 
cidental. It  has  the  power  of  loco- 
motion, and  will  adapt  the  position 
of  its  rays,  one  after  the  other,  to  the 
crevices  of  the  rocks,  where  it  seeks 

and     obtains    its    food;    and    When    in          Nervous  system  of  the  star-fish,  drawn  from  a 
nftnn^Annn  ' 4.U    *i_ '  r  preparation  in  King's  College  Museum.     1,2,3. 

accordance   With  thlS  power  Of  appa-       Nerves  distributed  to .three  of  the  rays.    4.  One 

rently  commanding  the  execution  of    °ufrehs? twelve  gailglia-  5*  °"e  of  the  commi8 


Ovum  of  the 
chick,  24th  hour. 
(After  Dr.  Allen 
Thomson.)  The 
white  line  repre- 
sents the  rudi- 
ment of  the  ner- 
vous system. 


Fig.  10. 


54  COMPARATIVE    ANATOMY. 

i 

certain  offices  in  different  portions  of  its  frame,  we  detect  nervous  cords 
emanating  from  nervous  nodules,  we  are  induced  to  regard  them  as  in- 
struments employed  in  the  production  of  these  phenomena.  Tiedemann 
was  the  first  to  prove  decidedly  the  existence  of  a  nervous  system  in  the 
star-fish.  His  account  was  published  in  1816,*  accompanied  with  a 
beautiful  drawing  of  it,  representing  a  ring  surrounding  the  oesophagus, 
giving  off  a  filament  to  each  ray,  besides  ten  smaller  ones,  which  he  be- 
lieves to  descend  to  the  stomach  ;  at  the  same  time  he  observes  that  he 
could  not  discover  anything  like  ganglia.  Their  existence  has,  how- 
ever, been  since  distinctly  proved  ;  and  in  an  excellent  preparation  of 
the  twelve-rayed  star-fish  in  the  Museum  of  King's  College,  twelve  little 
nodules  of  neurine  or  ganglia,  one  opposite  each  ray,  may  be  distinctly 
seen,  from  which  fig.  10  is  taken. 

This  nervous  system,  simple  as  it  is,  forms  an  accurate  type  of  the 
most  complicated  in  the  highest  species  of  animated  beings,  containing, 
if  I  mistake  not,  exactly  the  same  number  of  elements;  and  the  distinct 
portions  to  which  we  must  now  attach  different  names,  should  peculiarly 
engage  the  student's  attention  when  thus  presented  to  his  observation 
under  this  the  most  simple  form.  When  called  upon  to  trace  the  same 
arrangement  in  the  human  being,  he  will  be  in  danger,  from  the  greater 
number  of  similar  parts  closely  connected  together  appearing  to  do  away 
with  this  fundamental  simplicity,  of  being  lost  in  the  labyrinth  of  per- 
plexing obscurity,  which  seldom  fails  to  disgust  those  who  attempt  to 
learn  the  structure  of  the  brain  in  the  ordinary  method. 

The  three  portions  may  be  designated,  ganglia  or  nervous  centres, 
commissures,  and  nerves. 

The  small  swellings  or  nodules  of  neurine,  are  the  ganglia. 

The  cords  which  pass  between  the  different  ganglia,  and  thus  connect 
them  together,  are  the  commissures,  or  apparatuses  of  union. 

The  cords  which  are  connected  to  the  ganglia  by  one  extremity,  and 
the  textures  of  the  different  organs  by  the  other,  are  the  nerves. 

The  term  ganglion  is  not  the  best  that  might  be  devised  for  the  de- 
signation of  this  portion  of  the  nervous  system,  as  merely  signifying  a 
knot :  it  only  characterizes  its  external  appearance,  without  in  the 
slightest  degree  implying  its  function  as  distinguished  from  the  nerves 
and  commissures. 

But  as  it  seldom  answers  to  attempt  a  decided  change  in  the  nomen- 
clature of  a  science  like  anatomy,  which  has  existed  for  so  many  years, 
it  will  perhaps  be  better  to  employ  the  same  term  in  the  comprehensive 
meaning  which  comparative  anatomy  justifies  us  in  adopting. 

Human  anatomists  have  been  too  much  in  the  habit  of  considering  a 
peculiar  rounded  form  essential  to  the  constitution  of  a  true  ganglion, 
not  usually,  therefore,  applying  the  term  ganglion  to  a  collection  of  cine- 
ritious  matter,  unless  moulded  into  a  knotted  form  and  supported  by  a 
dense  membrane:  thus  the  medical  student  has  been  led  to  imagine  that 
the  neurine  which  is  contained  within  the  human  skull,  is  altogether 
different  from  the  ganglia  of  the  lower  orders  of  animals,  merely  because 
it  differs  from  them  so  much  in  its  outward  appearance. 

*  Anatomie  der  Rohren-Holothurie  des  Pomeranzfarbigen  Seesterns  und  Stein. 


GANGLIA.  55 

But  the  fact  really  is,  that  if  the  terra  ganglion  be  correct  as  applied 
to  the  nodules  of  neurine  or  centres  of  power  in  the  lowest  animals,  it  is 
equally  correct  to  apply  it  to  those  of  the  highest ;  and  it  therefore  follows 
that  the  human  brain  is  but  a  series  of  large  ganglia.  Their  close  con- 
nection, and  the  great  size  of  the  commissures,  give  to  it  a  degree  of 
complication  which  we  can  only  unravel,  by  seizing  the  thread  at  this 
simple  though  perfect  type  of  a  nervous  system,  and  never  dropping  it 
till  it  has  conducted  us  through  all  the  various  additions  made  to  its 
fundamental  simplicity,  up  to  the  perfect  but  complex  organization  in 
the  human  being. 

That  a  peculiar  form  is  not  indispensable  to  the  constitution  of  a  gan- 
glion, even  according  to  the  confined  sense  in  which  that  term  is  used  in 
the  descriptive  anatomy  of  the  human  body,  is  proved  by  the  fact,  that 
a  simple  layer  of  cineritious  neurine  of  a  sernilunar  form,  lying  between 
the  dura  mater  and  skull  in  the  temporo-sphenoidal  fossa,  through  which 
the  posterior  root  of  the  fifth  pair  of  nerves  passes,  is  described  as  being 
perfectly  analogous  to  the  rounded  firm  knots  which  are  attached  to  the 
posterior  roots  of  all  the  spinal  nerves;  and  the  analogy  is  perfect :  but 
it  ought  to  teach  us  this  lesson — that  a  particular  form  is  not  essential  to 
the  constitution  of  a  ganglion.  I  think,  therefore,  that  we  are  justified 
in  extending  the  term  ganglion  ;  and  I  am  quite  sure  that  it  would  enable 
us  very  considerably  to  simplify  the  anatomy  of  the  human  brain,  if  we 
were  to  apply  it  thus  to  any  collection  of  cineritious  neurine  into  a  cir- 
cumscribed mass,  whatever  form  or  arrangement  it  may  assume:  for  in- 
stance, the  cineritious  neurine  which  forms  the  convoluted  surface  of  the 
hemispheres  of  the  human  brain,  I  should  denominate  the  Hemispherical 
Ganglia;  for  the  convoluted  appearance  arises  solely  from  the  circum- 
stance, that  it  was  necessary  a  contrivance  should  be  adopted  to  pack  a 
very  extensive  surface  into  a  small  space,  on  the  same  principle,  (and  I 
trust  that  the  homeliness  of  my  simile  will  be  excused  for  its  simplicity,) 
that  when  we  put  a  handkerchief  into  our  pocket,  we  fold  it  up  instead 
of  attempting  to  carry  it  about  us  spread  out  to  its  whole  extent.  Now 
there  would  be  just  as  much  reason  to  deprive  the  semilunar  ganglion 
of  its  generic  title,  and  give  it  a  name  merely  in  accordance  with  its 
appearance,  as  there  is  in  separating  the  hemispherical  ganglia  of  the 
human  brain  from  their  analogous  ganglia  in  the  lower  animals,  and 
designating  them  by  a  term  which  gives  a  mystery  to  their  character 
they  do  not  deserve. 

It  is  a  great  pity  that  anatomists  cannot  agree  upon  some  generic  title 
for  the  cortical  substance  of  the  human  brain,  so  as  to  distinguish  it  from, 
the  tubular  neurine  which,  with  it,  forms  the  hemispheres  of  the  brain. 
It  is  a  distinct  ganglion,  and  as  such  ought  to  have  a  name  ;  I  gave  it 
that  of  hemispherical,  because  it  appeared  to  me  the  best  that  could  be 
adopted  :  and  I  think  so  still ;  but  if  any  other  anatomist  had  re-named 
it  well,  I  would  have  followed  him  in  this  edition,  sooner  than  leave  it 
without  a  name.  There  would  be  just  as  much  sense  in  calling  the 
occipito  frontalis  muscle  the  cortical  substance  of  the  cranium,  as  there 
is  in  calling  the  hemispherical  ganglion  the  cortical  substance  of  the  brain. 

When  the  physiologist  is  engaged  in  the  difficult  task  of  discovering 
the  office  of  any  particular  apparatus  in  the  organism  of  an  animal,  there 


5#  COMPARATIVE   ANATOMY. 

are  few  proofs  which  are  so  clear  and  satisfactory  as  those  derived  from 
some  decided  peculiarity  of  structure  :  as  a  simple  instance,  we  may  cite 
the  tubular  form  of  arteries  and  veins,  convincing  us  that  they  are  in- 
tended to  carry  fluids,  and  the  valves  in  the  interior,  proving  to  us  that 
those  fluids  could  only  flow  in  one  direction.  Now  in  our  investigations 
into  the  functions  of  a  ganglion  as  distinguished  from  the  other  portions 
of  the  nervous  system,  it  is  true  that  we  shall  not  be  able  to  derive,  from 
the  study  of  its  structure,  proofs  of  its  function  so  clear  and  decided  as 
those  just  cited  in  reference  to  the  circulating  system.  The  gray  or 
pulpy  neurine  is  always  met  with  in  a  ganglion,  and  the  fibrous  alone 
enters  into  the  composition  of  a  nerve,  while  the  commissures  are  occa- 
sionally compounded  of  the  two.  This  circumstance,  independent  of  all 
that  has  been  already  advanced,  to  prove  that  the  nervous  power  is 
generated  by  the  vesicular  neurine,  would  be  almost  conclusive. 

If  it  be  true,  that -the  cineritious  matter  alone  is  endowed  with  the 
faculty  of  generating  or  producing  power,  while  the  medullary  is  simply 
capable  of  conducting  it,  we  must  conclude  that  the  nerves  are  not  only 
the  instruments  of  conduction,  but  that  those  portions  of  the  human  brain 
which  are  formed  of  medullary  neurine  must  perform  exactly  the  same 
function,  and  that  the  great  transverse  commissure  or  corpus  callosum, 
the  longitudinal  commissure  or  fornix,  and  in  fact  all  those  commissures 
into  whose  texture  the  medullary  neurine  alone  enters,  must  necessarily 
be  conductors  and  not  originators  of  the  peculiar  powers  by  which  the 
nervous  system  is  distinguished  from  every  other.  Is  it  not  then  ex- 
tremely probable  that  the  office  of  the  commissures  is  to  enable  the 
individual  to  compare  those  impressions  which  are  conducted  by  the 
nerves  of  sensation,  from  the  especial  organs  of  sense  in  which  they 
originate,  as  the  eye  and  the  ear,  to  the  hemispherical  ganglia,  the  seat 
of  judgment,  memory,  &c.  ? 

The  vital  phenomena  which  living  beings  present  to  our  observation 
are  of  two  kinds :  the  one  comprehends  all  those  functions  which  tend 
to  the  maintenance  and  preservation  of  their  individual  existence,  and 
the  reproduction  of  their  species ;  while  the  other  class  of  phenomena 
bring  them  into  relation  with  the  external  world,  informs  them  of  the 
existence  of  surrounding  objects,  and,  manifested  in  the  activity  of  the 
intellectual  faculties,  teaches  man  in  particular  the  properties  of  bodies 
and  the  laws  which  regulate  them.  Those  functions  by  which  the  nutri- 
tion and  growth  of  individuals  and  the  reproduction  of  species  are 
effected,  are  common  to  all  living  beings,  vegetables  as  well  as  animals, 
and  there  can  be  no  life  without  them  ;  but  the  second  order  of  functions, 
the  manifestation  of  which  proves  to  us  that  the  individual  is  capable  of 
receiving  impressions  from  external  nature,  and  of  reacting  upon  these 
impressions,  showing  thereby  a  consciousness  of  their  existence,  is  pecu- 
liar to  animals. 

All  true  physiologists,  even  from  the  time  of  Aristotle,  have  observed 
more  or  less  accurately  the  distinction  between  these  two  classes  of  phe- 
nomena; arid  arranged  them  accordingly.  Aristotle  conceived  that  they 
might  be  classified  under  three  heads— vital,  natural,  and  animal ;  the 
first  two  comprehending  those  which  we  now  combine  under  the  head 
of  vegetable  life. 


CYCLO-GANGLIONIC    SYSTEM.  57 

Galen  adopted  the  same  arrangement,  but  added  the  hypothesis  that 
these  functions  were  superintended  or  controlled  in  their  operation  by 
presiding  spirits;  something  in  the  same  way  that  some  physiologists  of 
the  present  day  believe  in  the  existence  of  a  single  vital  principle,  whose 
office  it  is  to  effect  all  the  various  vital  phenomena  which  are  presented 
to  our  observation  by  living  beings. 

Bichat  arranged  the  functions,  like  many  of  his  predecessors,  under 
two  heads;  but  instead  of  referring  the  power,  which  appears  to  regulate 
and  preside  over  these  phenomena,  to  some  mysterious  spirit,  he  con- 
sidered it  to  be  dependent  for  its  very  existence  on  the  nervous  system; 
and  this  led  him  to  divide  the  nervous  material  into  two  systems,  the 
one  of  which  he  called  the  nervous  system  of  organic,  perhaps  better 
called  vegetative  life,  and  the  other  of  animal  life. 

The  first  of  these  systems  in  man  was  formerly  designated  the  sym- 
pathetic nerve,  from  a  belief  that  it  arose  from  the  brain  in  a  similar 
manner  to  the  cerebral  nerves  in  general.  Its  title  of  sympathetic  was 
owing  to  the  idea  that  the  sympathy  which  exists  between  all  the  vital 
organs  was  dependent  for  its  existence  on  this  nerve.  The  idea  that  it 
arises  from  the  brain  is  erroneous;  for  it  differs  from  the  cerebral  nerves 
as  completely  as  the  brain  and  spinal  cord  themselves  do  from  the  nerves 
which  arise  from  them.  And  the  notion  being  rejected,  it  has  since  been 
called  the  ganglionic  system — a  name  which  I  think  objectionable,  in  as 
much  as  it  might  lead  the  student  to  imagine  that  those  nodules  of  neu- 
rine  called  ganglia  were  peculiar  to  this  system,  which,  as  he  advances 
in  his  studies,  he  would  find  to  be  erroneous. 

It  has  appeared  to  me  that,  in  describing  this  portion  of  the  nervous 
system  in  man,  it  would  be  better  to  designate  it  the  Cy 'do- ganglionic  or 
hetero-ganglionic  system,  as  corresponding  in  its  mere  anatomical  ar- 
rangement with  the  nervous  system  of  the  cyclo-gangliated  or  molluscous 
division  of  the  animal  kingdom. 

Physiologists  were  divided  in  opinion  as  to  which  of  the  two  systems, 
the  sympathetic  or  the  cerebro-spinal,  the  nervous  apparatuses  of  the 
lower  orders  ought  to  be  referred.  Before  the  sympathetic  system  had 
been  acknowledged  in  man  and  the  lower  animals  as  distinct  from  the 
cerebro-spinal  system,  every  appearance  of  a  nervous  system  was  very 
naturally  considered  as  corresponding  to  the  cerebro-spinal. 

But  after  the  sympathetic  system  was  admitted  to  be  independent  in 
its  powers  in  man  and  the  higher  animals,  physiologists,  looking  only 
to  resemblance  in  outward  appearance,  and  not  to  analogy  of  function, 
began  to  maintain  that  the  nervous  system  of  the  lower  orders  corre- 
sponded exactly  to  this,  the  system  of  vegetative  life  of  the  upper. 

It  is  now,  however,  generally  believed  that  where  a  distinct  nervous 
system  is  present,  and  there  is  an  evident  separation  of  the  animal  from 
the  organic  or  vegetative  functions,  in  all  probability  there  are  three 
presiding  nervous  systems  : 

1st.  The  cerebral  or  brain  system. 

2d.  The  true  spinal  or  excito-motory  system  of  Dr.  M.  Hall. 

3d.  The  sympathetic  or  cyclo-ganglionic  system,  the  system  of  organic 
life  of  Bichat. 

And  though  it  is  difficult,  most  probably  on  account  of  its  minuteness, 


58  COMPARATIVE    ANATOMY. 

in  many  of  the  lower  animals,  to  demonstrate  the  existence  of  the  nerv- 
ous system  of  vegetative  life,  as  distinct  from  that  of  animal  life,  there 
is  very  little  doubt  that  it  always  exists  ;  and  it  has,  in  fact,  lately  been 
demonstrated  in  many  of  the  lower  orders  where  its  presence  was  not 
previously  even  suspected. 

Dr.  Grant,  in  speaking  of  the  nervous  system  as  developed  generally 
in  the  animal  kingdom,  says — "  The  nerves  of  sensation  and  motion 
closely  accompany  each  other,  forming  by  their  union,  cords  or  columns, 
or  a  cerebro-spinal  axis ;  but  the  sympathetic  nerves,  appropriated  to 
the  more  slow  and  regular  movements  of  organic  life,  form  a  more  iso- 
lated system,  and  these  three  systems  are  developed  together,  almost 
from  the  lowest  animals."* 

The  following  literary  history,  from  Dr.  Fletcher's  Lectures,  of  the 
opinions  held  concerning  the  uses  of  the  ganglionic  nerves  from  Galen 
to  Brachet,  is  so  excellent  and  comprehensive,  that  I  think  its  introduc- 
tion in  this  place  will  be  acceptable  to  my  readers.  "  Before  the  time 
of  Galen  the  ganglionic  system  of  nerves  was  entirely  unknown  ;  and 
although  by  him  and  his  followers,  the  Arabians,  the  existence  of  this 
system,  as  well  as  its  supposed  origin  from  the  superior  maxillary  branch 
of  the  trigeminal  nerve,  was  pointed  out,  as  well  as  its  other  supposed 
origin  from  the  abductor  nerve  was  subsequently  by  Eustachius,  it  was 
not  till  the  time  of  Willis  that  the  ganglionic  nerves  were  generally 
considered  as  a  part  of  the  nervous  system  at  all. 

"  Willis,  however,  still  looked  upon  them  as  merely  an  appendage  to 
the  cerebro-spinal  system,  and  represented  them,  both  in  verbal  descrip- 
tions of  them  and  in  his  curious  diagrams  of  their  distribution,  as  grow- 
ing upon  the  latter  '  ut  frutex  super  alio  frutice.'  And  this  notion  hav- 
ing been  adopted  by  Vieussens  (Neurograph.,  1684J,  Lancisi  (Opera 
Omnia,  1745),  Meckel,  senior  (Memoires  de  Berlin,  1745),  Zinn  (ditto, 
1753),  Hoare  (De  Ganglia  Nervorum,  1772),  Scarpa  (De  Nerv.  Gang!., 
1779),  Monro  (On  the  Structure  and  Function  of  Nervous  Ganglia, 
1783),  Blumenbach  (Inst.  Physiol.,  1786),  Chaussier  (Exposition,  &c., 
1807),  Legallois  (Sur  le  Principe  de  la  Vie,  1812),  Beclard  (El.  d'Anat. 
Gen.,  1823),  Wilson  Philip  (On  the  Vital  Functions,  1817),  Mason 
Good  (On  the  Study  of  Medicine,  1825),  and  numerous  other  writers, 
both  before  and  since  the  time  that  their  independence  was  insisted  on 
by  Winslow,  it  has  become  a  very  prevalent  custom  to  regard  these 
nerves  as  of  very  secondary  importance;  and  the  names  imposed  upon 
the  system  in  general,  as  well  as  the  uses  assigned  to  it,  have  generally 
corresponded  with  this  idea. 

"  The  ganglions  of  the  sympathetic  nerve  were  supposed  by  Galen, 
their  discoverer,  to  act  as  buttresses,  in  order  to  strengthen  them  as 
they  recede  from  their  reputed  origin  ;  by  Willis  as  a  kind  of  diverticula 
to  the  animal  spirits  received  from  the  brain,  and  also  as  a  means  of 
keeping  up  a  sympathy  between  distant  organs:  Vieussens  and  Meckel 
adopted  the  same  opinion. 

"  Lancisi  looked  upon  them  as  forcing-pumps  adapted  to  propel  the 
animal  spirits  along  the  nerves. 

*  Outlines  of  Comparative  Anatomy,  Part  II. 


RADIATA.  59 

"The  doctrine  of  the  independence  of  the  ganalionic  system  was  es- 
poused by  Cuvier  (Lemons  d'Anat.  Comp.,  1799),  and  particularly  in- 
sisted on,  with  his  accustomed  eloquence,  by  Bichat  (Sur  la  Vie  et  la 
Mort,  1802),  who  represented  all  the  ganglions  of  this  system  as  cdes 
centres  particuliers  de  vie  organique,  analogues  au  grand  et  unique  cen- 
tre de  la  vie  animate  qui  est  le  cerveau  ;'  and  who  further  demonstrated, 
not  only  that  all  these  ganglions  were  collectively  independent  of  the 
cerebro-spinal  system,  but  that  each  ganglion  was  independent  of  every 
other ;  nay,  that  each  nerve  proceeding  from  such  a  ganglion  was  in  a 
great  measure  independent  of  that  ganglion,  and  even  that  each  point  of 
such  nerve  was  independent  of  all  the  rest,  and  constituted,  per  se,  a 
distinct  focus  of  nervous  influence. 

"  Richerand  (Phys.,  1804),  and  Gall  (Anat.  et  Phys.  du  Syst.  Nerv., 
1810),  adopted  similar  tenets  ;  and  they  are  further  inculcated  by 
Wutzer  (De  Corp.  Hum.  Gang!.,  1817),  and  Broussais  (Journal  Univ. 
des  Sc.,  1818),  the  latter  in  particular  describing  the  ganglionic  system 
of  nerves  as  possessing  a  peculiar  kind  of  sensibility  (i.  e.,  irritability), 
with  which  it  immediately  endows  all  the  organs  destined  for  nutrition, 
secretion,  and  the  other  organic  functions,  and,  by  means  of  its  repeated 
connections  with  the  cerebro-spinal  system,  all  organs  of  the  body. 

"  Brachet,  in  an  especial  manner  (Sur  les  Fonctions  du  Syst.  Nerv. 
Gangl.,  1823),  distinctly  represents  the  ganglionic  system  of  rierves  as 
the  seat  of  '  imperceptible  sensation,'  and  as  presiding  in  an  especial 
manner  over  the  several  viscera  of  the  body." 

In  directing  our  attention  to  the  relation  which  the  development  of 
the  nervous  system  bears  to  the  manifestations  of  consciousness  in  each 
individual  of  the  animal  kingdom,  it  is  interesting  to  observe  the  rela- 
tive position  which  the  nervous  system,  in  its  simplest  form,  holds 
to  the  alimentary  canal :  we  must  not,  however,  attempt  to  account  for 
this  circumstance  by  supposing  that  the  presence  of  a  nervous  system  is 
necessary  to  the  solution,  digestion,  and  assimilation  of  the  alimentary 
matter ;  for  these  processes  are  perfectly  executed  by  the  fresh-water 
Polypus,  or  Hydra  viridis,  in  which  there  is  not  the  slightest  trace  of  a 
nervous  system.  Almost  the  whole  existence  of  the  lowest  order  of  ani- 
mals appears  devoted  to  the  acquirement  of  food  and  the  reproduction  of 
their  species  ;  apparently  they  answer  no  other  end  in  creation  than  that 
of  elaborating  a  nutrient  material  for  others  that  hold  a  higher  rank  in 
the  animal  kingdom  ;  and  the  whole  of  their  vital  energies  being  de- 
voted to  this  object,  we  cannot  be  surprised  that  those  organs  which 
are  expressly  constructed  for  its  fulfilment,  should  be  surrounded  by,  and 
thus  intimately  connected  with,  that  system  (the  nervous)  by  which  the 
animal  is  informed  of  the  existence  of  surrounding  things,  and  is  fitted 
to  act  upon  these  to  the  extent  of  its  limited  necessities. 

In  the  animal  which  we  have  last  described,  the  star-fish,  it  is  evident 
that  one  of  the  earliest  forms  of  nervous  system  which  is  cognizable  to 
our  senses  presides  over  the  motive  apparatus  of  the  animal.  But,  let 
it  be  remembered,  it  does  not  follow  that  such  motions  necessarily  indi- 
cate any  volition  or  consciousness  on  the  part  of  the  animal  executing 
them.  The  nerves  of  the  star-fish,  like  the  spinal  nerves  in  man,  may 
most  probably  be  divided  into  two  classes,  the  excito  and  the  motory,  or 


60  COMPARATIVE    ANATOMY. 

the  incident  and  the  reflex  ;  the  motor  nerves  arising  in  the  ganglia,  and 
distributed  to  the  arms, — the  excitor  arising  round  the  mouth,  and  termi- 
nating in  the  ganglia.  In  this  individual  all  the  ganglia  are  of  equal 
dimensions,  none  predominating  in  size  over,  or  differing  in  function 
from  the  rest ;  there  is  no  concentration  of  power :  all  is  equally  diffused. 
The  office  performed  by  the  nervous  system,  even  of  this  simple  animal, 
cannot  be  understood  without  a  further  knowledge  of  Dr.  M.  Hall's  view. 
Our  readers  will  then  be  better  prepared  to  understand  the  function  of 
the  various  ganglia  of  the  Articulate  and  Molluscous  divisions  of  the 
animal  kingdom.  They  will  also,  after  seeing  these  ganglia  scattered 
about  the  bodies  of  the  lower  animals,  again  recognize  them  in  a  more 
concentrated  form  in  the  human  being,  and  thus  receive  a  clue  to  their 
analogies  in  the  human  being,  when  they  are  presented  in  a  more  con- 
centrated form.  Dr.  Marshall  Hall,  in  the  preface  to  his  first  work  on 
this  subject,  thus  states  his  views:  "First.  That  there  is  a  source  of 
muscular  action  equally  distinct  from  voluntary  motion,  and  from  motion 
resulting  from  the  irritability  of  the  muscular  fibre.  Second.  That  there 
is  a  series  of  incident  excitor  nerves,  and  of  reflex  motor  nerves,  which, 
with  the  true  spinal  marrow  as  their  centre  or  axis,  constitute  the  true 
spinal  system,  as  distinguished  from  the  cerebral,  through  which  that 
muscular  action  is  excited.  Third.  That  the  ingestion  and  egestion  of  air 
and  of  food,  and  the  action  of  the  orifices  and  sphincters  of  the  body,  are 
dependent  upon  this  system.  No  physiologist  has  observed  that  the 
action  of  the  larynx  and  pharynx  in  deglutition  and  vomiting,  and  in 
respiration,  and  that  of  the  sphincters,  continually  depends  upon  the  spinal 
marrow  and  certain  excitor  and  motor  nerves.* 

"  The  eyelids  close  when  the  eyelash  is  touched,  through  the  same 
agency  of  excitor  and  motor  nerves,  and  of  the  spinal  marrow." 

Respiration  has  been  shown  to  depend  upon  the  medulla  oblongata. 
But  this  part  of  the  spinal  marrow  has  been  erroneously  supposed  to  be 
the  source  and  primum  mobile  of  this  function  ;  whereas  Dr.  M.  Hall 
believes  he  has  ascertained  that  the  pneumo-gastric  is  that  primum  mo- 
bile, as  the  principal  excitor  nerve  of  respiration : 

"  The  action  of  the  ejaculators  obviously  depends  upon  the  same 
excito-motory  or  true  spinal  system." 

The  fourth  of  Dr.  Hall's  views  is,  "  That  the  true  spinal  system  is 
the  exclusive  seat  of  convulsive  diseases ." 

The  fifth  is,  "  That  the  same  system  is  the  seat  of  action  of  certain 
causes  of  disease  and  of  certain  remedial  agents" 

Legalloisf  and  Mr.  MayoJ  have  shown  "  that  distinct  portions  of  the 
spinal  marrow  have  distinct  functions;  but  these  functions  have  been 
confounded  with  sensation  and  with  voluntary  and  instinctive  motion, 
and  have  remained  both  unexplained,  and  without  any  application  to 
physiology  or  pathology." 

Dr.  Hall  left  to  others  the  task  of  applying  his  principle  to  the  eluci- 
dation of  the  physiology  of  the  nervous  system  of  the  lower  animals. 

*  In  order  to  see  the  proofs  of  this  remark,  the  reader  need  only  turn  to  the  justly  popular 
works  of  Mayo,  "Physiology,"  ed.  3,  pp.  113,  114,  361,  &c.;  and  of  Magendie,  ed.  3  &  ]  1, 
pp.65— 68,  I32,&c. 

t  CEuvres,  Paris,  1824,  p.  62,  &c.  J  On  Human  Physiology,  pp.  230,  231. 


ARTICULATA.  61 

Mr.  Grainger  was  the  first  who  pointed  out  the  instruments  by  which 
these  excito-motory  actions  are  performed  in  man,  and  their  analogues 
in  the  lower  animals. 

In  his  admirable  work  on  the  spinal  cord,  he  thus  expresses  himself: 
"  The  anatomical  characters  of  the  invertebrated  animals  afford,  how- 
ever, the  most  striking  evidence  of  the  true  formation  of  the  spinal  cord, 
and  corroborate,  in  a  manner  not  to  be  mistaken,  the  account  that  has 
been  given  in  the  preceding  pages,  of  the  anatomical  arrangement  of  the 
spinal  nerves.  In  the  immense  division  of  the  Articulata,  it  is  found 
that  the  nerves  of  the  body  are  attached  to  masses  of  a  granular  gray 
substance,  but  hitherto  the  true  relations  existing  on  the  one  hand  be- 
tween the  nerves  and  these  masses,  and  on  the  other  hand  between  the 
latter  and  what  is  considered  as  the  brain,  have  not  been  determined.  A 
careful  examination,  however,  of  that  descending  and,  as  it  were,  gra- 
duated scale  which  is  formed  by  the  nervous  system  in  the  animal  king- 
dom, consequently  demonstrates  that  the  Articulata  possess  parts  which 
are  the  exact  analogues  of  the  structures  that  exist  in  the  Vertebrata.  It 
was  surmised  by  Sir  C.  Bell,  that  there  exists,  from  the  worm  up  to  man, 
a  series  of  nerves  subordinate  to  sensation  and  volition,  constituting 
what  that  profound  physiologist  called  the  regular  or  symmetrical  nerves, 
— a  supposition  which  has  been  in  part  realized  by  the  beautiful  discovery 
of  Newport,  who  has  proved  the  identity  of  the  gangliated  thread  of  the 
Articulata  with  the  spinal  cord  of  the  vertebral  animals.  This  writer 
has  not,  it  is  true,  referred  to  any  division  of  the  motor  and  sentient 
nerves  into  two  orders  of  fibres,  similar  to  those  which  are  capable  of 
demonstration  in  the  Vertebrata,  nor  have  I  been  hitherto  able  to  detect 
such  an  arrangement;  but,  when  we  consider  the  remarkable  intricacy 
and  minuteness  of  the  whole  structure  in  these  animals,  and  recollect 
how  lately  even  the  two  roots  themselves  have  been  discovered,  it  may 
be  well  permitted  us  to  doubt  if  the  entire  anatomy  of  these  nerves  is 
yet  known. 

"It  is  seen  on  inspection  that  the  nerves  are  attached,  as  has  already 
been  stated,  to  the  ganglions,  which  bodies  are  themselves  connected 
by  a  few  delicate  longitudinal  threads,  which  also  extend  from  the  upper- 
most ganglion  to  the  brain.  Now  from  the  analogy  of  the  vertebrated 
animals,  it  may  be  assumed  that  these  threads  consist  in  part  of  longitu- 
dinal commissures,  by  which  the  ganglia  are  combined  in  their  functions, 
and  in  part  of  true  sensiferous  and  volition  filaments,  which  terminate  in 
the  brain.  In  descending  the  scale,  from  the  most  perfect  animal  to  the 
lowest  classes  in  which  a  symmetrical  nervous  system  exists,  it  is  seen 
that  exactly  as  the  motions  of  the  body  become  independent  of  the  brain, 
the  nerves  contain  a  larger  proportion  of  those  fibres  (the  true  spinal) 
which  terminate  in  the  substance  of  the  spinal  cord,  and  fewer  cerebral. 
But  it  is  most  erroneous  to  assert,  as  some  authors  have  done,*  that  in 
the  invertebrated  animals  the  spinal  cord  is  not  directly  continuous  either 
with  the  brain  or  with  itself;  on  the  contrary,  wherever  there  is  a  gray 
mass  in  the  head,  however  minute,  which  corresponds  in  office  with  the 
brain,  a  connection  with  the  nerves  through  the  medium  of  the  spinal 

*  Fletcher's  Rudiments  of  Physiology,  PI.  2  b,  p.  87, 


62  COMPARATIVE    ANATOMY. 

cord  is  indispensable  to  the  exercise  of  that  voluntary  control  over  the 
motions  of  the  body  which  in  these  instances  always  exisls. 

"In  the  invertebrate  animals  thus  endowed, there  is  in  fact  no  difference 
in  the  type  of  the  cerebro-spinal  axis,  when  contrasted  with  that  of  the 
Vertebrata;  there  are  innumerable  varieties  of  form,  but  in  every  instance 
the  essential  structures  have  a  real  existence."" 

Dr.  William  Carpenter  followed  Grainger  in  this  path,  and  in  the 
fullest  and  in  the  most  philosophical  manner  has  brought  the  anatomy  of 
the  Mollusca  to  elucidate  this  subject.  Dr.  Carpenter  enunciated  his 
views  in  his  inaugural  Thesis,  printed  in  1839. t 

I  shall  avail  myself  largely  of  its  contents  in  the  following  observations 
on  this  subject.  In  his  Introductory  Remarks  he  says,  "  One  of  the 
principal  objects  which  the  author  has  kept  in  view,  has  been  to  ascer- 
tain how  far  Dr.  M.  Hall's  doctrine,  regarding  the  distinctness  of  the 
excito-motor  from  the  sensori-volitional  system  of  nerves,  accords  with 
the  data  furnished  by  comparative  anatomy." 

One  great  advantage  to  be  gained  by  studying  the  nervous  system  of 
the  invertebrate  class  of  animals  is,  that  the  centres  are  so  completely 
isolated,  and  the  nerves  which  they  distribute  so  easily  traced,  and  the 
organs  they  supply,  that  it  is  much  easier  to  discover  the  probable  office 
of  each  individual  ganglion  than  it  is  in  man,  where  they  are  so  closely 
packed,  and  the  connections  of  all  so  numerous,  that  it  is  not  easy  to 
decide  so  accurately  over  wrhat  organs,  or  sets  of  organs,  each  nervous 
centre  presides. 

Our  next  illustration  shall  be  selected  from  the  Molluscous  division  of 
the  animal  kingdom,  not  because  it  comes  next  in  the  ascending  scale 
of  animal  life,  but  because,  from  its  simplicity,  it  is  best  suited  to  our 
purpose.  It  is  from  the  class  TUNICATA;  in  external  appearance  they 
seem  but  little  raised  above  the  Sponges;  the  greater  part  of  them  pass 
their  whole  lives  in  one  situation,  attached,  like  the  Corals,  to  the  rocks 
— many  of  them  are  associated  on  one  stalk,  like  the  Polypes. 

These  animals  are  enveloped  in  a  tough  elastic  tunic  (the  analogue  of 
the  valves  of  the  Conchifera),  and  within  this  is  found  a  muscular  coat, 
consisting  of  fibres  crossing  each  other  in  various  directions,  by  which 
compression  may  be  exercised  on  the  contents  of  the  cavity  it  surrounds. 
Two  openings  penetrate  these  sacs;  one,  termed  the  branchial,  admits 
water  to  the  general  cavity,  partly  for  the  purpose  of  aerating  the  blood, 
and  partly  to  bring  food  to  the  digestive  orifice  ;  the  other,  termed  the 
anal,  gives  exit  to  the  current  which  has  passed  over  the  respiratory 
surface,  and  also  to  the  contents  of  the  intestine  and  ovaria.  These 
openings  are  bounded  by  distinct  circular  sphincters,  with  which  radiat- 
ing muscular  filaments  are  intermixed,  that  extend  in  longitudinal  bands 
over  the  surface  of  the  sac. 

By  means  of  this  apparatus,  the  animal  is  capable  of  diminishing  the 
capacity  of  the  branchial  sac,  and  thus  of  ejecting,  with  considerable 
force,  a  part  of  the  water  it  contains  ;  whilst  the  elasticity  of  the  external 

*  Observations  on  tlie  Structure  and  Functions  of  the  Spinal  Cord,  by  R.  D.  Grainger, 
1837. 

f  Physiological  Inferences  to  be  deduced  from  the  Nervous  System  of  the  Invertebrated 
class  of  Animals. 


TUN1CATA.  63 

tunic  spontaneously  restores  its  usual  dimensions  when  the  contracting 
power  is  inactive.  No  movements  of  this  kind,  however,  are  commonly 
employed  either  for  the  respiratory  process  or  for  the  prehension  of  food. 

A  continuous  and  equable  current  of  fluid  enters  the  branchial  orifice, 
and  is  propelled  by  the  anal,  without  any  other  visible  physical  agency 
than  the  movement  of  the  cilia,  which  cover  the  aerating  surfaces. 
The  mouth,  or  entrance  to  the  stomach,  is  situated  at  the  entrance  of 
the  branchial  sac,  and  is  unprovided  with  any  special  sensory  apparatus; 
it  seems  to  derive  its  supplies  from  the  respiratory  current  alone,  and 
not  to  depend  upon  any  prehensile  movements;  but  particles  unfit  to 
enter  it  are  probably  stopped  at  the  branchial  orifice.  Moreover,  as  each 
animal  possesses  within  itself  all  the  organs  necessary  for  the  propaga- 
tion of  its  race,  and  as  these  appear  contrived  simply  for  the  passive 
evolution  of  germs,  no  powers  of  active  motion  are  called  into  exercise 
by  the  performance  of  this  function. 

So  far  as  the  regular  vital  operations  are  concerned,  therefore,  we  see 
indications  of  voluntary  actions  in  these  animals,  or  even  of  that  kind  of 
respondence  to  impressions  which  would  lead  us  to  suspect  the  existence 
of  a  connected  nervous  system.  But  in  the  simultaneous  contraction  of 
the  whole  muscular  sac,  which  is  occasionally  witnessec),  we  can  scarcely 
fail  to  acknowledge  the  operation  of  nervous  agency. 

If  one  of  these  animals  be  touched  when  its  cavity  is  full  of  water,  a 
jet  of  fluid  is  thrown  out  to  some  distance,  and  sometimes  a  number  are 
so  closely  impacted  together  on  the  rocks,  that  the  impression  given  to 
one,  causes  it  suddenly  to  retract,  which  acts  also  on  the  one  next  to  it, 
and  so  on  throughout  several  of  them,  and  each  in  contracting  throws 
out  a  quantity  of  water.  We  find,  accordingly,  on  examining  into  the 
characters  of  the  nervous  system,  that  it  is  most  simple  in  its  structure 
and  distribution.  We  have  here  no  repetition  of  parts,  as  in  the  Radi- 
ata,  and  one  ganglion  serves  as  the  centre  of  all  the  actions  to  which 
this  system  ministers.  This  ganglion  lies  between  the  two  orifices,  and 
sends  filaments  towards  each,  as  well  as  others  that  ramify  upon  the 
muscular  sac,  to  which  they  seem  almost  exclusively  confined. 

In  fig.  11  are  seen  the  position  of  the  ganglia  and  the 
distribution  of  its  filaments  in  Ascidia  mammillata.  Fig.  n. 

The  nervous  filaments  which  pass  to  the  branchial  ori- 
fice, diverge  to  enclose  it,  and  meet  again  beyond,  so 
as  to  form  a  complete  ring. 

The  only  organs  of  special  sensation  that  this  animal 
can  be  regarded  as  possessing,  are  the  tentacular  fila- 
ments which  fringe  the  interior  of  the  branchial  orifice. 
Although  nothing  is  absolutely  known  of  their  function, 
it  would  not  seem  improbable  that  they  are  susceptible 
of  impressions  from  substances  entering  with  the  respi- 
ratory current,  which,  being  propagated  at  the  ganglion, 
may  excite  the  closure  of  the  sphincters  by  means  of  the 
motor  nerves,  and  thus  prevent  the  admission  of  inju- 
rious  bodies.  Should  this  be  the  case,  we  can  hardly  system,  ieuvier.)  a. 

1.1,.  ,,  ,  i       •         i  Branchial  orifice,     b. 

regard  the  action  as  of  more  than  a  sympathetic  charac-  Anai.  «.  Ganglion, 
ter,  since  the  closure  of  the  sphincters  in  the  higher  ani-  ™£..Tadiating  fila" 


COMPARATIVE   ANATOMY. 


mals  is,  in  like  manner,  independent  of  the  impulse  of  volition,  although 
capable  of  being  influenced  by  itA  It  would  seem  probable,  too,  that  by 
the  same  sphincters  is  regulated  the  quantity  of  water  which  shall  enter  for 
the  supply  of  the  respiratory  and  digestive  organs,  in  accordance  with  their 
requirements,  communicated  in  like  manner  through  the  ganglion,  and 
the  ciliary  movements  would  appear  to  be  under  the  same  control  (al- 
though not  so  in  the  higher  animals),  since  in  those  beings  which  make 
use  of  them  in  the  acquirement  of  food,  such  as  the  common  wheel  ani- 
malcule, they  stop  and  re-commence  in  such  a  manner  as  to  prevent  the 
observer  from  assigning  any  other  cause  to  their  variations. 

Passing  from  this  polype-like  Mollusk  to  one  a  little  advanced  in  the 
scale  of  existence,  and  which,  though  still  chained  to  the  rocks  during 
its  whole  existence,  has  some  slight  power  of  taking  cognizance — we 
refer  to  the  oyster.  It  has  no  locomotive  power  ;  almost  the  only  mus- 
cular power  it  enjoys  is  that  by  which  it  closes  its  shell,  its  opening 
being  accomplished  by  the  elasticity  of  a  ligamentous  hinge.  Garner* 
has  stated  that  distinct,  though  very  simple,  organs  of  vision  may  be 
observed  on  the  margin  of  the  mantle.  It  has  long  been  known  to  fish- 
ermen that  the  shadow  of  a  boat  passing  over  a  bed  of  oysters  will  cause 
them  to  close  their  shells :  this  we  can  hardly  suppose  would  occur,  if 
they  were  not  supplied  with  some  form  of  the  apparatus  of  vision. 

The  sensitive  tentacula  which  guard  the  alimentary  canal  are  now 
developed  from  the  true  mouth,  and  two  pairs  of  long  flexible  tentacula, 

or  palpi,  with  which  the  mouth  is  furnished, 
Fig.  12.  seem  designed  to  guard  its  orifice. 

The  principal  ganglion  in  the  oyster  (fig. 
12,  B)  is  situated  by  the  adductor  muscle, 
between  the  branchi;  it  maybe  called  the 
posterior  ganglion  ;  it  is  the  analogue  of  the 
ganglion  in  the  creature  we  have  just  been 
examining,  (the  Ascidia,)  and,  like  it,  re- 
ceives its  command  from  the  respiratory 
surface  and  the  mouth,  by  the  excitor,  or 
afferent  nerves,  which  arise  there,  and  ter- 
minate in  the  ganglion.  Like  it,  it  stimu- 
lates to  contraction  the  adductor  muscle  of 
the  shell.  Its  analogue  in  man  and  the 
Vertebrata  generally,  is  the  medulla  oblon- 
gata,  in  which  the  ganglia  of  the  pneumo- 
gastric  nerves  are  situated.  In  addition  to 
this  ganglion,  there  are  two  small  ganglia 
(A)  situated  near  to  the  mouth,  and  the  ru- 
dimentary organs  of  sense  which  guard  the 
alimentary  canal.  Whatever  consciousness 
this  animal  enjoys  of  external  nature,  is  most 
probably  dependent  on  these  ganglia — they 
are  the  analogues  of  the  cerebral  ganglia  in 
man.  The  oyster,  as  we  have  seen,  has  no  power  of  locomotion,  no  in- 


Nervous  system  of  oyster.  (Garner.) 
A  A.  Anterior  ganglia.  B.  Posterior 
or  branchial  ganglion  inlobed.  a  a. 
Branches  to  mouth,  c.  Ditto  to  gills. 
d  d.  Connecting  trunks,  e.  Transverse 
filaments,  uniting  anterior  ganglia.  /. 
Arch  over  oesophagus. 


*  Linnean  Transactions,  vol.  xvii.  part  iv.  p.  485. 


CONCHIFERA.— GASTEROPODA.  65 

struments  of  progression  ;  but  in  the  same  class,  the  Conchifera?,  or  shell- 
bearing  Mollusks,  we  find  some  endowed  with  the  power  of  moving  from 
place  to  place. 

The  organ,  which  is  a  single  one,  and  is  called  the  foot,  is  a  firm  mus- 
cular structure;  sometimes  it  is  employed  in  burrowing  in  mud  and  sand, 
and  sometimes  in  executing  sudden  and  rapid  motions— true  leaps — by 
which  the  animal  is  enabled  to  change  its  place  with  great  celerity.  The 
interesting  point  to  us  is  not  the  existence  of  the  contractile  muscular 
organ,  the  foot,  by  which  the  motion  is  effected,  as  the  piston  of  the 
steam-engine  is  by  the  expansive  power  of  the  steam,  but  the  existence 
of  a  little  bit  of  vesicular  neurine,  from  which  this  muscle  derives  its 
order  to  contract  and  move  the  animal,  and  without  which  neurine  the 
muscle  would  be  powerless,  paralyzed,  and  flabby. 

"  Wherever  the  foot  exists  in  the  Conchiferse,"  says  Dr.  Carpenter, 
"  we  find  an  additional  ganglion  in  close  relation  with  it,  being  usually 
situated  at  its  base,  and  following  its  changes  of  position,  as  well  as  cor- 
responding with  it  in  degree  of  development" — the  pedal  ganglion. 

In  these  Mollusks  we  have  here,  then,  the  cephalic  ganglia,  or  brain, 
the  instrument  of  consciousness  and  director  of  all  voluntary  movements ; 
the  posterior  respiratory  ganglion,  or  medulla  oblongata,  belonging  to 
the  excito-motory  system,  directing  the  respiratory  movements;  the  pedal 
ganglion,  exciting  all  the  instinctive  motions  of  the  foot,  the  analogue 
of  one  segment  of  the  spinal  cord  in  man,  or  one  of  the  ganglia  com- 
posing the  jointed  cord  in  insects.  "  It  is  important  to  remark,"  says 
Dr.  Carpenter,  u  that  whilst  the  pedal  ganglion  and  the  respiratory  gan- 
glion are  always  connected  with  the  anterior  ganglia,  or  cerebral  ganglia, 
they  are  never  immediately  connected  with  each  other.  This  would 
seem  to  indicate  that  their  functions  are  distinct,  though  partly  depend- 
ent on  the  influence  of  the  anterior  ganglia." 

The  next  class  of  Mollusca,  the  Gasteropoda,  are  known  to  us  in  the 
familiar  forms  of  the  snail,  the  slug,  and  the  limpet.  These  creatures  are 
much  advanced,  in  their  relations  to  the  external  world,  above  the  oys- 
ter and  the  conchiferous  Mollusks  we  have  just  been  considering.  They 
enjoy  the  sense  of  sight  and  smell,  and  having  thus  the  power  of  distin- 
guishing their  food,  have  a  more  perfect  organ  of  locomotion  to  enable 
them  to  seek  and  select  it.  The  union  of  two  individuals  is  necessary 
for  the  reproduction  of  their  species,  and  we  find,  in  accordance  with 
higher  powers,  larger  and  more  numerous  ganglia  for  their  executing 
their  motions.  In  some  of  the  species,  as  in  the  limpet,  for  instance,  we 
find  these  centres  of  power  very  distinct,  while  in  others,  as  in  the  com- 
mon slug,  there  is  no  anatomical  line  of  distinction,  and  they  are  so 
united,  that  we  can  only  demonstrate  their  individuality  by  referring  to 
the  nerves  connected  with  them.  This  fact  has  an  important  bearing  on 
the  anatomy  of  the  human  body,  and  teaches  us  that  we  must  not  there 
look  for  an  anatomical  line  of  demarkation  as  necessary  to  decide  on  the 
individuality  of  the  ganglia. 

We   shall  find,   when   we  come  to  the  dissection  of  the  medulla 
oblongata,  that  there   are  two  ganglia  imbedded  in  its  substance,  so 
closely  connected,  that  we  can  scarcely  distinguish  them  except  by 
5 


COMPARATIVE    ANATOMY. 


Nervous  system  of 
the  patella,  or  limpet. 
(Garner.)  A  A.  Cephalic 
ganglia.  B  B.  Branch- 
ial, c  c.  Pedal.  D.  Pha- 
ryngeal.  E.  Labial. 


Fig.  14. 


Fig.  13.  observing  the  connection   of  their  nerves.     The  au- 

ditory and  pneumogastric  ganglia  are  .here  referred 
to.  In  the  patella,  or  limpet,  (see  fig.  13,)  we  ob- 
serve at  the  base  of  the  tentacula,  and  rather  anterior, 
therefore,  to  the  ffisophagus,  a  pair  of  ganglia  (A  A), 
which  evidently  correspond  to  the  anterior  ganglia 
in  the  Conchifera,  which  are  connected  by  a  commis- 
sural  band  passing  over  the  oesophagus.  These,  how- 
ever, not  only  send  nerves  to  the  tentacula,  but  are 
also  connected  with  their  eyes  which  are  situated  at 
their  base.  Beneath  the  cesophagus,  and  connected 
by  two  trunks  with  each  of  the  cephalic  ganglia,  we 
find  a  broad  mass,  which,  on  examination,  appears  to 
consist  of  four  lobes  placed  in  a  line. 

The  two  inner  ones  (c  c)  send  nerves  to  the  foot,  and  are  thus  analo- 
gous to  the  pedal  ganglia  of  Conchifera.  These  are  connected  with  the 
cephalic  ganglia  by  one  of  the  trunks  which  we  observe  on  each  side. 
Externally  to  them  are  the  branchial  ganglia  (B  B),  which  are  also  con- 
nected to  the  cephalic  ganglia  by  a  separate  trunk,  and  with  each  other 
by  a  filament,  which  may  be  distinctly  traced  through  the  pedal  ganglia.* 

"  Besides  these  nerves,  we  find  in  the  patella, 
as  well  as  among  the  Gasteropoda  in  general,  a 
separate  system  connected  with  a  very  important 
set  of  organs,  the  gustatory  and  the  mandieatory, 
which  are  but  slightly  shadowed  out  among  the 
Conchifera.  In  these  animals  we  find  the  oeso- 
phagus dilated  at  its  commencement  into  a  mus- 
/f^/W  ^\^\\  cular  cavity,  with  a  curious  rasp-like  tongue, 
*/'  II I  y\\  \  wh*ch  sei"ves  to  reduce  the  food,  often  supported 
upon  cartilages,  and  sometimes  furnished  with 
horny  maxillaB.  The  nerves  which  supply  these 
do  not  proceed  directly  from  the  cephalic  gan- 
glia, but  are  part  of  a  distinct  system,  which 
sends  its  ramifications  along  the  oesophagus  and 
stomach,  and  which  is  occasionally  connected 
with  the  first  by  inosculating  filaments.  In  the 
Limax  ater,  or  common  slug,  we  find  the  cepha- 
lic ganglia  (A  A)  united  into  one  large  bilobed 
mass,  lying  completely  above  the  cesophagus. 
Another  large  mass  or  sub-cesophageal  ganglion 
forms  the  lower  part  of  the  ring,  and  is  connected 
with  the  first  by  two  trunks  on  each  side.  A 
little  examination  will  show  that  this  ganglion, 
like  the  similar  mass  in  the  patella,  is  composed 
of  two  pairs  of  nerves,  having  distinct  functions. 


Nervous  system  of  the  com- 
mon slug.  (Baly.)  A  A.  Cephalic 
ganglia.  B  B.  Branchial,  c. 
fedal.  D.  Pharyngeal. 


The  branches  from  the  outer  portion  (B)  are  principally  distributed  to  the 
respiratory  sac,  and  this  will,  therefore,  be  analogous  to  the  outer  or 
branchial  portion  of  the  ganglionic  mass  in  the  patella,  being,  like  it, 

"  ' 


^*  Garner,  be. 


GASTEROPODA. 


67 


connected  immediately  with  the  cephalic  by  a  trunk  of  its  own.  The 
inner  portion  (c)  does  not  send  its  branches  to  the  foot  in  particular,  but 
to  the  general  muscular  surface  in  which  this  organ  is,  as  it  were,  lost, 
and  of  which  the  whole  body  is  concerned,  in  the  progressive  movement 
of  the  body.  Hence,  we  may  fairly  regard  this  as 
a  locomotive  ganglion.  Two  small  pharyngeal 


Fig.  15. 


ring, 


con- 


ganglia  are  found  within  the  principal 
nected,  as  usual,  with  the  cephalic."* 

The  next  specimen  of  a  nervous  system  to  which 
we  shall  direct  our  attention,  is  taken  from  the  third 
sub-kingdom,  the  Homo-Gangliata,  or  Articulated 
animals  of  Cuvier.  This  is  almost  as  simple  in  its 
arrangement  as  that  just  referred  to  ;  although,  in 
general  appearance,  it  approaches  more  nearly  to 
that  of  the  higher  orders.  Fig.  15,  taken  from  Dr. 
Grant's  Outlines  of  Comparative  Anatomy,  repre- 
sents the  nervous  system  of  the  common  sandhop- 
per,  or  Talitrus  Locusta;  and  it  will  be  seen  that 
here,  likewise,  all  the  ganglia  are  of  nearly  equal 
size,  and  nearly  at  equal  distances.  The  cephalic 
ganglia  are  the  most  anterior,  and  are  a  little 
larger  than  the  rest;  the  respiratory  ganglia  are  on 
the  side,  and  detached ;  and  the  pedal  ganglia, 
which  are  numerous,  are  situated  in  the  separate 
segments  of  this  jointed  body.  It  will  be  seen  that 
the  cerebral  and  spinal  ganglia,  placed  on  the  same 
side  of  the  mesial  line,  are  connected  together  by 
two  sets  of  longitudinal  fibres,  cerebral  columns  of 
volition  and  sensation.  The  fibres  which  connect 
corresponding  ganglia  on  opposite  sides  of  the  me- 
sial line,  are  analogous  to  the  corpus  callosum  in 
the  human  brain  and  transverse  fibres  in  the  spinal 
cord.  This  form  of  nervous  system  is  seen  in  the 
embryos  of  the  higher  orders  of  the  Crustacea. 

The  next  stept  onwards  in  the  evolution  of  the 
nervous  system  consists  in  the  approach  and  close 
connection  of  the  two  longitudinal  cords,  and  their 
accompanying  ganglia,  or  to  the  concentration  of 
these  into  apparently  a  single  cord  as  well  as  single 
ganglia.  This  form  is  beautifully  illustrated  by  that 
of  the  Cymothea  (fig.  16). 

We  have  already  seen  how  much  the  arrange- 
ment of  the  ganglia  of  the  Mollusca  confirms 
Dr.  M.  Hall's  theory  of  an  excito-motory  system  of  nerves, 
recent  researches  of  Mr.  Newport  into  the  anatomy  of  the  nervous 
system  of  the  Myriapoda,  completes  more  perfectly  the  chain  of  evi- 
dence. Indeed,  so  satisfactory  to  my  mind  are  his  discoveries  of  the 
existence  of  a  distinct  set  of  nerves  for  the  execution  of  the  instinctive 
movements,  that  I  have  no  doubt  whatever  that  there  is  exactly  the 

*  Dr.  Carpenter,  op.  cit. 


15.  From  Grant's  Outlines 
of  Comparative   Anatomy. 
Nervous  System  of  the  Ta- 
litrus  Locusla,  or   common 
sandhopper.     All  the   gan- 
glia, eleven  in  number,  are 
of  nearly  equal  size;    the 
two    first,    which    are    the 
supra-ffisophageal,  scarcely 
exceeding    in    dimensions 
any  of   the    others.      The 
ccsophagus    runs    between 
the  two  first  pairs  of  gan- 
glia. 

16.  Also    from    Grant's 
Outlines,  &c.,  presents  the 


ring  very  distinct,  but  the 
supra-cesophageal  ganglia 
scarcely  developed.  The 
two  longitudinal  cords,  with 
the  pairs  of  ganglia  united, 
so  as  to  form  a  uniform 
cord. 


But  the 


68  COMPARATIVE   ANATOMY. 

same  simple  arrangement  in  the  structure  of  the  spinal  cord  of  all  verte- 
brate animals,  not  excepting  man,  though  at  present  we  have  not  been 
able  to  unravel  it  with  our  dissecting  knives,  or  trace  all  its  component 
fibres  with  the  microscope. 

The  Myriapoda,  of  which  the  common  centipede  is  a  familiar  example, 
have  several  cephalic  ganglia  situated  at  the  anterior  extremity  of  the 
body,  and  connected  with  the  organs  of  sense,  the  eyes,  antenna?,  &c. 
Mr.  Newport  states,*  that  in  the  embryo  of  Necroph.  leophagus  (Geophi- 
lus),  longicornis  (Leach),  at  the  moment  of  bursting  its  shell,  the  brain 
is  composed  of  four  double  ganglia,  the  centres  of  a  corresponding 
number  of  segments,  which  are  then  becoming  aggregated  together,  so 
as  to  form  this  single  movable  portion  of  the  head  ot  the  perfect  animal ; 
so  that  the  brain  of  the  Myriapoda,  and  probably  of  all  the  higher  Arti- 
culata,  is  in  reality  composed  of  at  least  four  pairs  of  ganglia.  The  first 
ganglia  being  devoted  to  the  nerves  of  the  antenna?,  may,  I  think,  be 
regarded  as  analogous  to  those  which  we  shall  see  in  the  Vertebrata 
devoted  to  the  olfactory  nerves.  The  next  mass  in  the  perfect  insect, 
as  in  the  embryo,  I  conclude  consists  of  two  pairs,  composed  of  the 
hemispherical  or  volitional  ganglion,  and  the  optic  ganglion.  This 
view  of  the  homology  of  the  second  pair  of  ganglia  will  be  better  under- 
stood by  the  student  when  we  come  to  the  brain  of  the  Fish.  It  is  very 
clear  that  it  is  not  solely  the  optic  ganglion,  in  as  much  as  it  exists  even 
when  the  organs  of  vision  are  entirely  wanting,  as  in  the  whole  of  an 
extensive  family  of  Chilognatha — the  Polydesmidce.  The  next  pair  supply 
the  mandibles  and  maxillae.  Emanating  from  these  ganglia,  there  are 
nervous  cords,  like  the  crura  cerebri  in  man,  which  run  down  and  enter 
into  the  composition  of  the  spinal  cord,  similar  to  those  we  have  just 
observed  in  the  Talitrus.  These,  he  considers,  are  the  conductors  of 
volition  and  sensation,  and  give  off  minute  branches  at  each  segment  of 
the  body  to  each  of  the  spinal  nerves :  as  the  powers  of  volition  and 
perception  are  very  low,  so  are  these  instruments  very  minute.  The 
spinal  cord,  as  a  whole,  is  very  large  in  proportion  to  the  brain,  because 
its  ganglia  and  their  own  especial  nerves,  constituting  the  excito-motory 
system,  or  system  of  instinctive  and  unconscious  movements,  are  large 
and  predominant. 

The  ganglia  of  organic  life,  the  analogues  of  the  so-called  sympathetic 
nerve  in  man,  are  also  very  fully  developed ;  distributed  in  a  great  part 
to  the  salivary  glands. 

The  visceral  ganglia  in  lulus  are  of  most  extraordinary  size,  being 
nearly  half  as  large  as  the  brain  itself.  There  are  four  on  each  side  the 
oasophagus,  closely  connected  in  one  series,  extended  along  the  cesopha- 
gus  as  far  as  the  middle  of  the  first  or  pro-thoracic  segments,  giving  off 
branches  of  nerves  to  the  immense  salivary  glands,  to  the  oesophagus 
itself,  and  surrounding  structures.  They  exhibit  the  appearance  of  gray 
nervous  matter  inclosed  in  a  distinct  theca. 

They  communicate  with  the  vagus  nerve,  which,  after  passing  beneath 
the  brain,  forms  a  minute  ganglion  immediately  behind  it,  which  is  also 
connected  to  the  lateral  ganglia  by  a  very  minute  branch  on  either  side. 
It  then  passes  along  the  oesophagus,  and  forms  the  second  larger  rounded 

*  Phil.  Trans.,  1843,  p.  248. 


MYRIAPODA.  69 

ganglion  first  mentioned  as  connected  to  the  last  of  the  lateral  ganglia. 
After  this  it  continues  its  course  backwards,  half  way  along  the  ffisopha- 
gus,  and  then  divides  into  two  branches,  which  are  given  off,  as  in  in- 
sects, to  the  posterior  part  of  this  organ,  and  to  the  cardiac  extremity  of 
the  stomach. 

One  of  the  most  interesting  circumstances  connected  with  the  develop- 
ment of  the  nervous  system  in  lulus,  is  the  relative  size  of  the  brain  as 
compared  with  that  of  these  ganglia  of  the  viscera.  "  In  these  inferior 
Myriapoda,"  says  Mr.  Newport,  "  in  which  the  power  of  locomotion  is 
distributed  equally  to  every  segment  of  the  body,  the  brain  itself  forms 
but  a  small  proportion  of  the  whole  nervous  system,  and  the  faculties  of 
sense  are  less  perfect  than  in  insects ;  while  the  nerves  of  organic  life, 
and  their  ganglia,  are  nearly  equal  in  volume  (as  in  lulus)  to  the  whole 
brain,  the  organ  of  volition.  The  very  reverse  of  this  is  the  case  in 
insects." 

"  In  those  in  which  the  faculties  of  sense,  more  especially  of  vision 
and  smell,  and  the  power  of  voluntary  motion,  are  carried  to  their  greatest 
extent — as  in  Volant  insects,  the  gregarious  Hymenoptera,  Neuroptera, 
and  Lepidoptera — the  volume  of  brain  bears  a  much  larger  proportion  to 
the  rest  of  the  nervous  system,  and  the  ganglia  of  organic  life  a  smaller. 
This  is  more  especially  the  case  in  the  perfect  insect,  in  -which  the 
volume  of  the  brain  is  not  merely  relatively,  but  actually,  increased  in 
size  during  the  changes  from  the  larva  to  the  perfect  state  ;  thus  leading 
to  the  inference,  that  the  importance  of  the  visceral  nerves  is  gradually 
diminished  in  proportion  as  those  of  active  volition  and  active  existence 
become  augmented.'^ 

"  The  spinal  cord  in  the  Myriapoda  is  extended  from  its  commence- 
ment in  the  crura  of  the  brain,  and  medulla  oblongata,  or  first  sub-ceso- 
phageal  ganglion,  to  the  antepenultimate  segment  of  the  body,  and  is 
almost  uniform  in  size  throughout  its  whole  length.  It  is  slightly  larger 
at  its  anterior,  and  smaller  at  its  posterior  extremity,  than  in  the  middle 
part  of  its  course.  In  lulus  terrestris  it  has  ninety-six  very  minute  gan- 
glionic  enlargements  situated  entirely  on  the  under  surface  of  the  cord, 
and  so  closely  approximated  together  as  not  to  be  observable  except  on 
very  close  inspection.  Each  of  these  enlargements  gives  off  two  pairs 
of  nerves,  one  of  which,  on  the  under  surface,  is  given  to  the  legs,  and 
the  other,  on  the  lateral  and  superior  surface,  to  the  sides  of  the  body ; 
so  that  the  whole  number  of  nervous  trunks  from  the  cord,  including 
those  from  the  medulla  oblongata,  is  ninety-four  pairs  to  the  head  and 
sides  of  the  body,  and  ninety-two  pairs  to  the  legs,  making  in  the  whole 
186  pairs,  or  372  nervous  trunks  from  the  cord,  exclusive  of  those  which 
belong  more  immediately  to  the  brain.  Each  enlargement  of  the  cord 
gives  off  at  its  upper  and  lateral  surface  a  single  nervous  trunk,  which 
passes  outwards  some  distance  as  a  single  nerve,  but  which  in  reality 
includes  two  distinct  sets  of  nerves,  that  separate  as  principal  trunks  at 
the  inner  side  of  the  great  longitudinal  series  of  abdominal  muscles." 

The  anterior  of  these  trunks  is  the  analogue  of  the  respiratory  nerves 
of  insects,  and  passes  across  the  upper  layer  of  these  muscles,  on  their 
visceral  surface,  giving  off  to  them  many  minute  branches. 

*  f\ 

*  Op.  cit. 


COMPARATIVE   ANATOMY. 


Fig.  17. 


The  Structure  of  the  Cord  is  thus  described  by  Mr.  Newport :  "  The 
formation  of  the  great  abdominal  cord  in  the  lulidae,  by  the  lateral  ap- 
proximation of  two  distinct  portions,  is  indicated  on  its  upper  surface  by 
a  slight  median  sulcus,  and  on  its  under  surface  by  a  slight  longitudinal 
division  between  the  two  approximate  ganglia  that  form  each  of  its  en- 
largements. Each  of  these  lateral  divisions  of  the  cord  in  lulus,  as 
formerly  shown  in  the  Scolopendra  and  other  Articulata,  is  a  compound 
structure,  formed  of  two  distinct  series  of  longitudinal  series  or  columns 
of  fibres,  which,  notwithstanding  the  different  explanation  that  has  been 
given  of  their  function  since  I  had  the  honor  of  first  describing  them  to 
the  Royal  Society,  are  quite  distinct  from  each  other,  although  closely 
approximated  together.  By  the  aid  of  means  superior  to  those  formerly 
employed  in  my  investigations,  I  now  find  that  the  abdominal  cord  con- 
tains other  structures  besides  those  already  described." 

"  In  my  former  communication  to  the  Royal  Society,  I  indicated  the 
existence  of  fibres  that  run  transversely  through  the  ganglia  of  the  cord 
in  the  larva  of  the  common  butterfly,  and  similar  structures  have  since 
been  shown  by  Dr.  Carpenter  in  other  Articulata,  and  applied  to  explain 
some  of  the  reflex  phenomena  of  the  nervous  system,  in  accordance  with 

the  theory  promulgated  by  Dr.  M.  Hall.  But 
besides  these  two  sets  of  longitudinal  fibres, 
and  the  series  that  pass  transversely  through 
the  ganglia,  there  are  other  structures  in  the 
cord  that  have  hitherto  been  entirely  over- 
looked. These  are  the  fibres  that  run  longi- 
tudinally, in  part  of  their  course,  at  the  sides 
of  the  cord,  and  enter  into  composition  of  all 
the  nerves  from  the  ganglia.  These  fibres  I 
shall  designate  the  fibres  of  reinforcement  of 
the  cord."— (Fig.  17,/) 

u  The  superior  longitudinal  set  of  fibres  of 
the  cord,  which  I  formerly  de- 
scribed as  the  motor  tract,  and 
to  which  the  function  of  volition 
A  seems  still  to   be   accorded    by 

Valentin,  Carpenter,  and  Baly, 
is  extended  in  lulus,  as  in  other 
Articulata,  as  a  separate  fascicu- 
lus along  the  upper  surface  of  the 
cord  ;  but  in  these  Myriapoda  it 
is  much  narrower  in  proportion 
to  the  whole  width  of  the  cord 
than  in  insects.  The  fact  is  in- 
teresting in  reference  to  its  pre- 
sumed- function.  On  a  cursory 
inspection,  it  does  not  appear  to 
give  off  any  branches,  but  seems 
to  pursue  its  course  uninterrupt- 

TTnder  surface  of  the  cord  in  Spiro  streptus.    (New-  ,  i         i  ,  i  LIT          *u       f 

port.)    a.  Inferior  longitudinal  fibres— sensory  tract.        edly  along    the    whole    length    OI 

Laibfibresf reinforcement-  c'  Nerves"  *  Commis-     the  cord.  It  does  not  indeed  give 


Upper  surface  of  the  cord  in  Spiro 
streptus.  (Newport.)  b.  Covering 
of  the  cord,  e  e.  Superior  longitu- 
dinal fibres — volitional  or  motor 
tract.  /.  Fibres  of  reinforcement. 
g.  Commissural. 


Fig.  18. 


MYRIAPODA.  71 

off  filaments  to  the  nerves  from  a  ganglion  immediately  opposite  their 
origin,  while  passing  over  that  ganglion,  but  immediately  it  has  passed 
one  ganglion,  it  gives  off  the  filaments  that  proceed  to  the  nerves  from 
the  next  ganglion  These  filaments  seem  almost  immediately  to  join 
with  others  that  belong  to  the  sides  of  the  cord,  and  pass  out  with  them 
into  the  nerve  from  the  next  ganglion  along  its  anterior  surface." 

"  This  is  almost  precisely  the  manner  in  which  the  filaments  from  the 
aganglionic  column  in  the  Crustacea  are  united  with  those  from  the  gan- 
glionic,  as  formerly  shown  in  my  description  of  the  nerves  in  that  class, 
when  the  existence  of  the  lateral  fibres  of  the  cord  was  unknown  to  me. 
The  inferior  longitudinal  or  ganglionic  set  of  fibres  (fig.  18,  a)  of  the 
cord,  affords  many  interesting  considerations.  It  is  placed,  exactly  as  in 
insects,  on  the  under  surface,  but,  like  the  upper  series,  it  is  narrower 
than  the  whole  cord,  of  which  it  forms  a  part.  It  is  formed  of  a  longi- 
tudinal series  of  fibres,  like  the  upper  track,  beneath  which  it  is  placed, 
and  from  which  it  is  divided  by  some  of  the  fibres  that  pass  transversely 
through  the  cord,  and  which  enter  into  the  composition  of  the  nerves 
from  the  ganglion  on  either  side.  It  appears  also  to  receive  filaments 
from  the  upper  series,  and  perhaps  others  are  sent  from  it  to  the  upper, 
thus  decussating  each  other  in  the  middle  substance  of  the  cord  when 
these  two  longitudinal  series  are  in  close  apposition  ;  since  it  is  almost 
impossible,  even  in  the  large  nervous  cord  of  Scolopendra,  to  separate 
the  two  tracts  from  each  other,  although  their  distinctness  is  evinced  in 
their  relative  size  and  longitudinal  lines  of  separation." 

"  But  there  is  one  fact  of  great  interest  in  regard  to  these  ganglionic 
series  of  fibres.  Almost  the  whole  of  the  fibres  of  which  it  is  composed 
are  traceable  in  the  Iulida3  directly  through  each  enlargement  of  the  cord, 
which  they  mainly  assist  to  form.  At  the  anterior  part  of  each  enlarge- 
ment, the  diameter  of  each  fibre,  or  fasciculus  of  fibres,  appears  to  be 
slightly  increased,  and  its  structure  becomes  more  soft  and  delicate. 
While  passing  through  these  ganglionic  enlargements,  occasioned  chiefly 
by  their  own  increased  diameter,  the  fibres  take  a  slightly-curved  direc- 
tion outwards,  and  then  inwards,  but  are  reduced  to  their  original  size, 
and  assume  the  longitudinal  direction,  on  again  forming  the  ganglionic 
portion  of  this  tract  of  the  cord.  This  structure  of  the  fibres  is  well 
seen  in  lulidse  and  Polydesmidffi,  as  I  shall  hereafter  again  have  occasion 
to  refer  to  more  especially,  with  reference  to  the  true  structure  of  gan- 
glia. The  fibres  are  traceable  most  distinctly  in  the  lulidaB  (fig.  19,  i). 

"  These  are  the  structures  to  which  I  formerly  assigned  the  function 
of  voluntary  motion  and  sensation,  and  to  which  I  am  still  inclined  to 
believe  they  minister,  since  the  fibres  of  which  both  are  composed  are 
traceable  to  the  crura  of  the  brain.  Whether  these  functions  are  re- 
stricted separately  to  the  two  structures,  as  I  first  imagined,  the  one  to  the 
upper,  the  other  to  the  inferior  series,  or  whether  they  are  administered 
to  conjointly  by  both,  through  an  interchange  of  fibres,  it  is  almost  im- 
possible to  determine  by  any  decisive  experiment  on  these  animals, 
although  the  structures  themselves  are  distinct.  But  in  the  absence  of 
experimental  proof,  there  are  circumstances  connected  with  the  distribu- 
tion of  the  nerves  to  the  extremities  which  seem  to  indicate  that  these 
low  forms  of  Articulata  are  endowed  with  a  power  of  sensation  and 


»  COMPARATIVE   ANATOMY. 

feeling  far  beyond  what  has  of  late  been  adjudged  to  them  by  some 
physiologists." 

u  In  some  of  the  gigantic  Spirostrepti  and  Spiroboli  the  legs  are 
adapted  for  climbing  up  the  trunks  and  branches  of  trees,  by  the  under 
surface  of  the  first  and  second  basilar  joints  of  the  tarsi  being  developed 
into  a  soft  cushion  or  pad,  as  in  some  insects ;  and  to  these  limbs,  I  have 
found  the  nervous  fibres  more  extensively  distributed  than  to  any  other, 
— a  fact  most  strictly  analogous  to  that  of  the  distribution  of  nerves  in 
the  tactile  parts  of  the  limbs  of  Vertebrata." 

"Those  fibres  of  the  cord  which  seem  to  be  independent  of  the  sets 
just  described,  and  which  do  not  appear  to  have  any  direct  communica- 
tion with  the  great  seat  of  sensation  and  volition — the  brain — are  of  two 
kinds,  which  may  justly  be  regarded  as  involuntary  in  their  functions. 
The  first  of  these  are  the  commissural  fibres,  (figs.  17,  g;  18,  d,)  which 
pass  through  the  ganglia  ;  and  the  second  are  those  which  have  hitherto 
been  undescribed,  and  form  the  sides  of  the  cord  (f)  in  the  interspace 
between  the  ganglia,  or  between  certain  nerves  distributed  from  them — 
the  fibres  of  reinforcement  of  the  cord." 

"  The  fibres  of  reinforcement  of  the  cord  form  the  lateral  portions  of 
the  whole  nervous  cord  of  the  body,  and  enter  into  the  composition  of 
all  the  nerves.  They  constitute,  as  it  were,  circles  of  nervous  commu- 
nication between  two  nerves  that  originate  from  the  cord  at  a  greater  or 
less  distance ;  and  form  part  of  the  cord  in  the  interval  between  these 
nerves,  and  bear  the  same  relation  to  the  segments,  individually,  which 
the  cord  itself  does  to  the  whole  body.  They  form  a  part  of  the  nerv- 
ous trunks  which  come  off  from  its  upper,  or  aganglionic  tract,  as  well 
as  of  those  which  proceed  from  the  ganglionic  enlargements  in  the 
lower,  and  in  each  instance  they  bound  the  posterior  side  of  one  nerve 
and  the  anterior  of  another,  to  which  they  proceed  along  the  side  of  the 
cord,  forming  in  the  interspace  a  part  of  its  structure.  Each  fibre  may 
thus  be  traced  from  its  peripheral  distributions,  in  the  structures  of  the 
external  surface  of  the  body,  inwards  along  the  course  of  the  nerves,  on 
their  posterior  surface  to  the  cord,  where  its  direction  is  altered  from 
that  of  the  nerve  transversely  inwards,  to  that  of  the  cord  on  which  it  is 
reflected,  and  passes  longitudinally  backward  ;  thus  forming  a  part  of  its 
external  surface  until  it  arrives  at  the  root  of  the  nerve,  to  which  it  is  to 
be  distributed,  and  along  which  it  again  passes  transversely  outwards, 
bounding  the  anterior  surface  of  the  nerve  to  its  distribution  on  the  late- 
ral surface  of  the  body.  These  fibres  of  reinforcement  form  a  large  pro- 
portion of  the  whole  cord,  and  enter  into  the  composition  of  the  upper 
anterior,  and  part  of  the  inferior,  surface  of  the  root  of  every  nerve  in 
their  course  inwards  to  the  cord  ;  and  of  its  posterior  and  inferior  sur- 
face on  their  again  proceeding  outwards.  In  this  manner  these  fibres  of 
reinforcement  connect  all  the  nerves  of  the  cord  on  one  side  of  the  body, 
as  the  corresponding  fibres  do  those  on  the  opposite  side.  They  form, 
as  it  were,  double,  triple,  or  quadruple  circles,  one  within  the  other. 
Thus  the  fibres  that  pass  inwards  along  one  nerve  may  proceed  along 
the  cord  to  pass  outwards  again  on  the  front  of  a  second,  a  third,  or  a 
fourth,  linking  the  segments  in  one  continued  series  of  nervous  commu- 
nications independent  of  the  brain.  But  these  communications  exist 


MYRIAPODA.  73 

only  between  nerves  on  the  same  side  of  the  body,  and  "not  between 
those  on  the  opposite.  The  commissure  nerves  connect  the  opposite 
sides  of  each  individual  segment,  as  those  of  reinforcement  do  the  same 
sides  of  two  separate  segments." 

"  Every  nerve  from  a  ganglionic  enlargement  of  the  cord  is  thus  com- 
posed of  four  sets  of  fibres,  an  upper  and  an  under  one,  which  commu- 
nicate with  the  cephalic  ganglia;  a  transverse  or  commissural,  that  com- 
municate only  with  the  corresponding  nerves  on  the  opposite  side  of  the 
body ;  and  a  lateral  set  that  communicate  only  with  the  nerves  from  a 
ganglionic  enlargement  on  the  same  side  of  the  body,  and  form  part  of 
the  cord  in  the  interspace  between  the  roots  of  the  nerves.  It  is  by  the 
successive  additions  of  these  lateral  portions  of  the  cord  that  its  size  is 
maintained  almost  uniformly  throughout  its  whole  length  in  the  elon- 
gated bodies  of  the  Myriapoda.  On  examining  the  cord  very  closely,  I 
have  reason  to  believe  that  the  upper  and  inferior  sets  of  longitudinal 
fibres,  the  ganglionic  and  the  aganglionic,  are  somewhat  smaller  at  their 
posterior  than  at  their  anterior  extremity,  a  circumstance  readily  under- 
stood in  the  fact  that  successive  series  of  filaments  are  given  off  from  them 
at  each  distribution  of  nerves  from  the  ganglionic  enlargements,  while 
the  relative  size  of  the  lateral  portions  of  the  cord  appears  to  be  greater 
in  the  posterior  than  in  the  anterior.  On 
this  account  I  have  named  these  lateral 
fibres,  fibres  of  reinforcement  of  the  cord. 
In  regard  to  the  identification  of  these 
fibres,  it  may  be  well  further  to  state  that 
their  separate  existence  is  indicated  chiefly 
at  the  postero-lateral  margin  of  the  gan- 
glia, (fig.  19, y,)  where  they  are  seen  to 
form  part  of  the  nerves  and  cord  without 
passing  upwards  to  the  brain.  In  other 
parts  of  their  course  they  are  not  distin- 
guishable by  color,  and  very  rarely  by  any 
longitudinal  line  of  separation,  from  the 
fibres  which  form  the  inferior  longitudinal  Ganglion  and  nerves  of  the  spinal 

cpripo    r>r  r»nrHrm  nf  tViP  rnrrl   tn   whioh  thpv      cord  of  Polydesmus  maculatus.    (New- 

senes,  or  portion  or  tne  com  to  wnicn  tney    port)    b   covering  of  the  cord.    c. 

are    approximated;    but     from    Which    they  Nerves  to  muscles,    d.  Posterior  nerves. 
.    r.r           ,             ,    '      ..      .             ,.             ,\        r      A  fk.  Fibres  of  reinforcement,    g  h.  Corn- 
are   believed    tO     be    distinct,  from    the    tact  missural  fibres.    I.  Fibres  of  the  inferior 
that  they  do  not  descend   with  them  tO  the  or  ganglionic  tract  passing  between  the 


brain." 

"  Their  function  must  be  regarded  only  as  reflex,  entirely  independent 
of  sensation,  but  capable  of  being  excited  into  action  by  external  causes. 
The  existence  of  these  lateral  fibres  in  the  cord  may  now  fully  explain 
the  reflected  movement  of  parts  anterior  or  posterior  to  an  irritated  limb 
on  the  same  side  of  the  body,  as  the  commissural  ones  do  the  move- 
ments of  the  parts  on  the  side  opposite  to  that  which  is  irritated.  The 
presence  of  these  fibres  in  the  cord  of  insects  I  had  long  suspected  from, 
the  curved  direction  of  the  fibres  that  formed  the  ganglia,  and  from  that 
of  the  origin  of  the  nerves,  from  the  aganglionic  tract,  as  figured  in  my 
former  paper;  and  although  I  had  communicated  this  opinion  to  a  friend 


74  COMPARATIVE   ANATOMY. 

several  years  ago,  I  have  never,  until  recently,  been  able  to  satisfy  my- 
self of  its  correctness." 

"  This  uncertainty  of  the  existence  of  any  structure  in  the  cord  that 
seemed  sufficient  to  explain  the  reflected  movements  on  the  same  side 
of  the  body,  independent  of  the  brain  and  the  nerves  of  volition  and  sen- 
sation, long  obliged  me  to  withhold  my  assent  now  received  respecting 
these  phenomena.  Although  the  fibres  that  pass  transversely  through 
ganglia  might  explain  the  fact  produced  on  one  side  of  the  body,  by  the 
irritation  of  a  corresponding  part  on  the  other,  there  seemed  no  anatomi- 
cal structure  to  account  for  the  movements  of  distant  parts,  anterior  or 
posterior  to  a  given  point,  if  the  doctrine  long  received,  that  each  fibre 
was  endowed  with  but  one  special  function,  were  correct." 

"  Now,  therefore,  that  we  find  an  anatomical  structure  in  the  cord 
that  seems  to  account  for  these  phenomena,  I  ought,  in  justice,  to  state 
that  Dr.  Hall, — to  whom  is  due  the  high  credit  of  collecting,  comparing, 
and  arranging  in  one  system,  numerous  facts  connected  with  the  reflected 
movements  of  animals,  as  observed  by  Whytt,  Blane,  and  others,  and 
also  by  himself, — adopting  the  principle  established  by  our  distinguished 
countryman,  Sir  Charles  Bell,  that  every  nervous  fibre  is  continued  un- 
broken, from  its  origin  to  its  termination,  and  is  capable  only  of  admin- 
istering to  one  special  function, — conceived  the  necessity  of  the  exist- 
ence of  special  nerves  for  the  reflected  movements,  and  that  at  the 
period  when  I  was  engaged  with  Dr.  Hall  in  his  experiments  on  this 
subject,  in  1833,  he  requested  me  to  examine  the  cord  in  the  hedgehog, 
to  ascertain  the  correctness  of  his  opinion.  This  examination  was  not 
made,  because  at  that  period  I  differed  from  him  in  attributing  the  re- 
flected movements  to  the  agency  of  another  part  of  the  nervous  system." 

"  Now  that  the  views  of  Dr.  Hall  seem  proved  to  be  correct,  I  am 
desirous  of  adding  this  testimony  of  the  acuteness  and  perception  of  one 
who  has  done  much  for  physiological  science." 

Professor  Owen's  testimony  on  this  subject  is  most  important  and 
satisfactory.*  After  describing  the  nervous  system  of  the  Crustacea,  he 
says  :  "  Three  principal  divisions  of  the  nervous  system  may  be  defined, 
according  to  the  views  which  I  entertain  of  their  functions.  Thus,  ad- 
mitting from  analogy,  that  the  supra-oesophageal  ganglionie  centre  is 
that  in  which  true  sensation  and  volition  reside,  the*n  those  nervous  fila- 
ments which  are  exclusively  connected  therewith,  and  some  of  which 
would  seem  to  extend  the  whole  length  of  the  animal  along  the  dorsal 
aspect  of  the  ganglionic  columns,  would  form  with  their  ganglionic 
centre  the  true  sensori-volitional  system,  whilst  any  other  ganglions 
superadded  to  the  abdominal  columns,  with  the  nervous  filaments  termi- 
nating in  or  originating  from  them,  would  constitute  the  system  for  the 
automatic  reception  and  reflection  of  stimuli.  The  stomato-gastric 
nerves,  connected  partly  with  the  brain,  and  partly  with  the  oesophageal 
columns,  will  form  a  third  system,  analogous  to  the  great  sympathetic 
or  organic  nerves  of  the  Vertebrata.  In  these  views  I  coincide  with 
that  ingenious  physiologist,  Dr.  Carpenter,  and  shall  feel  happy  if  their 
accuracy  and  soundness  have  received  any  additional  proof  from  the 

*  Owen's  Lectures,  vol.  i.  p.  173. 


CRUSTACEA.  75 

facts  of  Comparative  Anatomy,  which,  in  the  Hunterian  Lectures  of 
1842,  were  for  the  first  time  brought  to  bear  upon  this  interesting  pro- 
blem." 

From  these  most  interesting  discoveries  of  Mr.  Newport,  and  the  im- 
portant physiological  deductions,  which  are  drawn  so  justly  from  them, 
let  us  turn  to  a  form  of  nervous  system  which  will  serve  to  instruct  us 
how  wonderfully  Nature  varies  her  resources  according  to  the  task  she 
has  to  execute,  always  maintaining  real  simplicity  amidst  an  almost 
boundless  variety ;  teaching  us,  also,  that  the  shape  alone,  and  general 
outline  of  the  component  parts  of  a  nervous  system  in  the  lower  animals, 
will  guide  us  very  imperfectly  to  its  analogues  in  man,  and  that  we  must 
search  deeper  for  a  clue  to  unravel  the  structure  of  the  human  brain. 
Instead  of  simply  directing  our  attention  to  the  shape  of  the  ganglia, 
we  must  rather  consider  how  far  the  distribution  of  the  nerves,  which, 
we  believe,  to  be  the  conductors  of  the  power  generated  by  the  ganglia 
or  centres,  corresponds  in  the  specimens  we  select  for  illustration.  Guided 
by  this  principle,  we  can  always  discriminate  the  masses  of  neurine  or 
optic  ganglia,  in  which  the  optic  nerves  terminate  in  each  individual 
where  optic  nerves  exist,  and  so  of  all  the  other  centres  or  ganglia, 
which,  in  the  higher  tribes  of  animals,  especially,  are  found  so  closely 
united  that  the  whole  mass  appears  but  as  one,  when  it  is  called  the 
brain.  On  the  same  principle,  in  the  specimen  which  we  shall  next 
attend  to,  we  must  observe  that  the  collection  of  neurine  from  which 
the  nerves  of  the  extremities  arise,  though  wholly  dissimilar  in  shape,  is 
analogous  to  the  dotted  spinal  cord  of  the  Myriapoda  and  the  smooth 
cord  of  the  Vertebrata.  In  the  common  crab,  the  neurine,  which,  in 
the  last  described  species,  was  deposited  so  as  to  form  a  chain  of  ganglia 
spread  along  the  surface  of  the  abdomen,  is  collected  into  only  two 
masses,  the  one  situated  in  the  head,  and  the  other  in  the  thorax. 

The  anterior  of  these  ganglia,  the  supra-cesophageal, 
or  brain,  is  small  as  compared  with  the  posterior ;  for  Fig.  20. 

the  organs  of  sense,  whose  nerves  terminate  in  this 
centre  of  power,  are  as  yet  but  imperfectly  developed, 
while  the  muscular  system,  deriving  its  supply  almost 
entirely  from  the  posterior  or  thoracic  ganglion,  is 
large  and  powerful. 

The  anterior  ganglion  is  connected  with  the  poste- 
rior by  two  slender  nervous  threads,  volitional  and 
sensory  filaments,  which,  passing  on  each  side  of  the 
oesophagus,  form  with  the  ganglia  the  same  oesopha- 
geal  ring  we  have  before  observed. 

Advancing  from  this,  one  of  the  most  simple  forms 
of  the  nervous  system  in  the  Crustacea,  we  next  meet, 
in  some  of  the  insect  tribe,  with  a  very  decided  step 
towards  the  concentration  of  the  higher  orders  ;  for 
the  nervous  ring  round  the  commencement  of  the  alimentary  canal  re- 
ceives additional  ganglia  on  its  superior  surface,  until  the  whole  mass 
formed  by  the  union  of  these  nervous  centres,  or  instruments  of  con- 
sciousness, assumes  the  appearance,  and  seems  entitled  to  the  appellation, 
of  a  brain. 


COMPARATIVE   ANATOMY. 


The  intimate  connection  and  apparent  dependence  of  the  organs  of 
sense,  as  the  eye,  &c.,  upon  those  appropriate  masses  of  cineritious  or 
pulpy  neurine  in  which  their  nerves  terminate,  and  to  which,  therefore, 
we  suppose  the  impressions  of  light,  &c.,  received  on  their  peripheral 
expansions  transmitted,  in  order  to  become  perceived  by  the  animal,  is 
beautifully  illustrated  by  the  various  alterations,  which  take  place  in  the 
nervous  system  of  the  moth,  as  it  advances  from  the  caterpillar  to  the 
perfect  insect,  or  imago. 

It  would  be  inconsistent  with  my  purpose,  if  I  were  to  expect  the 


Fig.  21. 


Fig.  22. 


Fig.  21.— Nervous  system  of  the  larva  of  Sphinx  Ligustri  aAer  it  has  acquired  its  full  growth,  and 
about  two  days  previously  to  its  change  to  the  pupa  state.  (Newport.)  a.  The  supposed  brain,  or 
anterior  nodules  of  the  cord.  1.  The  first  ganglion  situated  in  the  head,  or  first  segment  beneath  the 
nodules.  2,  3,  4,  5.  Ganglia  of  the  trunk  supplying  nerves  to  the  legs  and  wings.  6,  7,  8,  9, 10, 11.  Ganglia 
of  the  abdomen,  b.  Nerves  to  the  mandibles,  c.  Second  pair  from  the  second  ganglion,  given  to  the 
muscles  of  the  neck.  d.  Third  pair,  given  to  the  first  pair  of  legs.  f.  Nerves  for  the  first  pair  of  wings, 
with  two  roots ;  one  from  the  cord,  and  one  from  the  third  ganglion,  and  connected  also  with  the  trans- 
verse plexus,  g.  Second  pair  of  nerves  from  the  third  ganglion,  given  to  the  second  pair  of  legs.  h. 
Transverse  plexus  from  the  third  ganglion,  ii.  Nerves  for  the  second  pair  of  wings,  originating,  like 
the  first,  from  two  roots,  one  from  the  cord,  and  one  from  the  fourth  ganglion,  and  connected  also  with 
branches  from  the  transverse  plexus  from  the  third,  k.  Second  pair  from  the  fourth  ganglion,  given  to 
third  pair  of  legs.  I.  Nerves  from  the  fifth  ganglion,  which,  in  the  pupa,  are  those  given  to  the  posterior 
muscles  of  the  trunk,  m.  Nerves  from  the  sixth  ganglion,  which,  in  the  pupa,  are  those  of  the  anterior 
muscles  of  the  abdomen,  n.  The  last  pair  of  nerves  from  the  terminal  ganglion,  given  to  the  rectum  and 
organs  of  generation. 

Fig.  22.— Nervous  system  of  the  Sphinx  Ligustri,  thirty  days  after  changing  to  the  pupa  state.  (From 
Newport.)  This  drawing  exhibits  the  abdominal  cords  in  their  shortened  state,  with  only  five  instead  of 
seven  ganglia,  the  fifth  and  sixth  having  passed  onwards  and  become  continuous  with  the  fourth.  The 
cords  in  the  trunk  and  the  nerves  to  the  wings  are  enlarged ;  and  those  nerves  which  in  the  larva  arose 
in  the  second  ganglion,  are  also  enlarged,  and  now  originate  from  the  cords,  while  the  first  ganglion  has 
advanced  very  near  to  the  superior  lobes  of  the  brain.  The  terminal  ganglion  exhibits  a  very  peculiar 
structure. 

Fig.  23. — Nervous  system  of  the  perfect  insect  Sphinx  Ligustri.  A.  Cerebral  ganglia.  B.  Optic  nerves. 
The  figures  refer  to  the  number  of  the  ganglia,  oooo.  Respiratory  nerves. 


INSECTA.  77 

student  to  follow  the  description  of  the  various  nerves  connected  with 
these  ganglia,  in  the  present  state  of  his  knowledge  ;  nor  do  I  conceive 
that  such  a  proceeding  would  diminish  his  difficulties  in  reference  to 
the  study  of  the  human  brain.  It  is,  however,  an  important  fact  in 
relation  to  the  function  of  neurine,  that  the  brain  of  the  perfect  insect  or 
imago  is  very  much  larger  than  that  of  the  caterpillar.  The  butterfly  is 
endowed  with  very  perfect  organs  of  sense  and  locomotive  powers, 
which  enable  it  to  roam  from  flower  to  flower,  and  perform  the  import- 
ant office  of  reproduction  :  its  organs  of  vision  are  large  and  complicated. 
The  poor  caterpillar  has  comparatively  imperfect  organs  of  sense,  and 
has  but  one  office  to  fulfil,  namely,  to  procure  food  and  convert  it  into 
nourishment  for  the  development  of  larger  nervous  centres,  and  a  more 
highly  endowed  animal.  By  reference  to  these  wood-cuts,  the  student 
will  observe,  in  fig.  21,  the  two  little  cerebral  ganglia  (a),  scarcely  larger 
than  the  infra-oesophageal  or  respiratory  (1). 

Without  following  out  each  different  stage  in  the  gradually  progressive 
change  which  the  nervous  system  of  the  larva  and  pupa  undergoes  pre- 
vious to  its  attaining  its  full  development  in  the  imago,  he  may,  after 
observing  the  relative  size  in  the  larva  (fig.  14),  and  the  gradual  concen- 
tration and  aggregation  of  the  spinal  or  locomotive  ganglia  in  the  pupa 
(fig.  22),  turn  to  fig.  23,  when  he  will  see  it  in  the  imago  or  perfect  insect. 

The  cerebral  ganglia  are  now  extended  transversely,  and  form,  with 
the  first  sub-oesophageal  ganglion,  and  the  enlarged  erura  which  connect 
them,  one  continuous  mass  around  the  resophagus  and  anterior  part  of 
the  dorsal  vessel.  The  second  ganglion  has  entirely  shifted  its  position, 
and  receded  towards  the  middle  of  the  thorax,  and  has  coalesced  with 
the  third,  which  has  entirely  disappeared,  and  seems  to  have  joined  in 
part  with  both  the  second  and  fourth,  and  the  intervening  cords.  This 
aggregation  of  ganglia  and  cords  is  situated  in  the  middle  of  the  thorax, 
and  supplies  all  the  muscles  in  that  part  of  the  body.  The  longitudinal 
cords  are  continued  from  the  hinder  part  of  the  fifth  ganglion,  and  just 
before  leaving  the  thorax  to  enter  the  abdomen,  they  give  off  the  nerves 
which  formerly  belonged  to  the  sixth  ganglion,  which  is  now  entirely 
obliterated.  The  cords  then  descend  into  the  abdomen,  and  immedi- 
ately give  off  the  nerves  that  belong  to  the  seventh  ganglion,  which, 
with  part  of  the  cord  that  existed  between  the  sixth  and  seventh  ganglia, 
is  also  obliterated.  The  cords  are  then  continued  in  a  direct  line  along 
the  abdomen,  the  8th,  9th,  10th  and  llth  ganglia  being  situated  as  in 
the  previous  stages.  Such  is  the  state  of  the  nervous  system  of  the 
perfect  insect. 

The  centre  of  the  nervous  system  of  the  sphinx  in  its  perfect  condi- 
tion is  covered  in  by  a  new  structure,  and  does  not  lie,  as  in  the  larva, 
in  the  open  cavity  of  the  thorax. 

Our  attention  having  been  directed,  in  the  instance  of  the  moth,  to  the 
progressive  development  of  the  encephalon  from  the  larva  to  the  imago, 
and  to  the  striking  increase  in  the  size,  and  greater  complexity  in  the 
form,  of  the  nervous  system  when  the  animal  becomes  fitted  to  receive 
impressions  from  the  objects  which  surround  it,  which  it  does  through 
the  medium  of  especial  organs  of  sense,  and  not  by  the  whole  surface  of 
the  body,  as  in  the  Medusa?  and  lowest  forms  of  animal  existence,  we 


78 


COMPARATIVE   ANATOMY. 


are  prepared  to  appreciate  similar  changes  in  some  of  the  higher  Mol- 
lusca,  and  to  inquire  how  far  the  nervous  organization  of  these  creatures 
will  countenance  the  opinion  that  there  is  an  intimate  relation  between 
the  bulk  of  cineritious  neurine  in  which  each  individual  nerve  of  sense 

Fig.  24. 


Nervous  system  of  the  Pearly  Nautilus.  (Owen.)  The  head  and  anterior  muscular  part  of  the  body  of 
the  Pearly  Nautilus  (Nautilus  Pompilitis,  Linn.),  laid  open  from  above  or  behind,  and  the  nervous  system 
displayed,  et.  The  cut  edges  of  the  musculo-ligamentous  disc  which  covers  the  head.  B  B.  The  open 
ends  of  the  digitations.  c.  Four  of  the  digital  tentacles  exposed  by  laying  open  the  canals  in  which  they 
are  lodged,  d  d.  The  anterior  ophthalmic  tentacles  similarly  exposed  at  their  origins,  e.  The  left  ex- 
ternal labial  process.  (The  corresponding  one  on  the  right  side  has  been  removed.)  /.  The  external 
labial  tentacles.  G.  The  internal  labial  tentacles,  h.  The  olfactory  laminie.  i.  The  internal  labial 
tentacles  of  the  left  side  similarly  exposed,  k.  The  origin,  on  the  left  side,  of  the  muscle  which  protrudes 
the  jaws.  I.  The  inner  concave  surface  of  the  great  shell-muscles,  m.  The  termination  of  the  right 
muscle,  n.  Orifices  by  which  the  vena  cava  communicates  with  the  abdominal  cavity,  o.  The  eye  laid 
open.  p.  The  pedicle,  q.  The  pupil  seen  from  within.  T.  The  cut-edge  of  the  sclerotic,  s.  The  retina. 
«.  The  dark  pigment  deposited  on  its  anterior  surface,  and  lining  the  cavity  of  the  globe.  1.  The  supra- 
cesophageal  ganglion  or  brain.  It  is  in  the  nautilus  in  the  form  of  a  simple  cord  or  commissure,  to  the 
extremities  of  which  are  connected  (2  2)  the  anterior  suboesophageal  ganglia.  3  3.  The  optic  ganglia. 
4  4.  The  posterior  sub-resophageal  ganglia.  5.  Buccal  and  pharyngeal  nerves.  6  6.  The  nerves  which 
supply  the  digital  tentacles,  and  in  the  cuttle-fish  the  acetabuliferous  arms.  7  7.  The  nerves  passing  to 
8  8,  the  internal  labial  ganglions.  9  0.  The  branches  to  the  internal  labial  tentacles.  10  10.  The  nerves  sup- 
plying the  olfactory  laminae.  11  11.  The  nerves  which  supply  the  infundibulum.  12  12.  The  nerves  of 
the  external  labial  tentacula.  13.  The  nerves  of  the  great  muscles  of  attachment.  14.  The  nerves  corre- 
sponding to  the  par  vagum.  15.  The  branchial  nerves.  10.  The  ganglions  communicating  with  the 
visceral  or  sympathetic  nerves,  and  supplying  the  heart,  venous  follicles,  and  abdominal  vise  ra. 


CEPHALOPODA.  79 

terminates,  and  the  perfection  of  the  organ  of  sense  from  which  that 
nerve  arises. 

However  much  we  may  have  had  reason  to  be  gratified  with  the  evi- 
dence which  our  investigations  into  the  development  of  the  moth  has 
afforded  us  of  the  existence  of  such  a  relationship,  we  shall  be  even 
more  delighted  with  the  clear  proof  of  the  universality  of  such  a  law, 
which  one  very  interesting  class  of  the  Molluscous  division  of  the  animal 
kingdom  in  particular  has  lately  yielded  to  the  physiologist:  I  allude  to 
the  admirable  Memoir  of  Mr.  Owen  on  the  Pearly  Nautilus,*  and  to  his 
account  of  the  structure  of  the  cuttle-fish,  published  a  few  months  ago  ;f 
and  whilst  I  do  so,  I  gladly  express  my  thanks  to  this  philosophical  ana- 
tomist, for  several  kind  and  valuable  hints  during  the  progress  of  this 
work. 

We  shall  first  consider  the  relations  that  exist  between  the  perfection 
of  the  organs  of  the  senses,  and  the  bulk  and  complexity  of  the  central 
portions  of  the  nervous  system  in  the  Pearly  Nautilus,  and  afterwards  in 
the  Cuttle-fish,  in  which  they  will  be  found  to  be  still  more  strikingly 
displayed  than  in  the  former. 

"  The  brain  or  supra-oasophageal  mass  in  the  Nautilus  (fig.  24)  con- 
sists of  a  transverse  cord-like  ganglion,  from  the  ends  of  which  three 
nervous  trunks  are  continued  on  each  side.  The  anterior  pair  pass 
downwards  and  forwards  by  the  sides  of  the  oesophagus  to  unite  below 
it,  forming  a  ganglion  on  either  side,  which  supply  the  digital  processes 
and  tentacles,  and  give  off  nerves  to  the  organ  of  smell  and  the  funnel. 
The  middle  and  superior  trunks  dilate  into  the  optic  ganglia ;  the  retina, 
which  terminates  that  of  the  left  side,  is  shown.  The  posterior  cords 
surround  the  oesophagus  in  a  manner  analogous  to  the  anterior  pair, 
forming  also  two  ganglionic  swellings,  from  which  the  nerves  of  the 
great  shell-muscle  and  those  of  the  viscera  are  given  off;  the  latter 
nerves  are  of  small  size,  and  are  continued  down  by  the  side  of  the 
great  perforated  vein,  and  are  analogous  in  their  distribution  to  the 
sympathetic  nerves  and  par  vagum." 

The  organization  of  the  Sepia  qfficinalis,  or  cuttle-fish  (fig.  25),  is 
peculiarly  interesting,  not  only  from  the  fact  that  it  offers  to  our  notice 
the  first  appearance  of  an  internal  skeleton,  an  apparatus,  which,  in  the 
Vertebrata,  is  constructed  in  intimate  relationship  with  the  nervous 
system,  and  is  often  entirely  appropriated  to  its  protection  ;  but  we  find 
this  rudimentary  skeleton  supporting  a  central  ganglion  of  unusual  di- 
mensions, and  a  nervous  system  very  highly  developed  in  many  of  its 
parts.  In  its  general  arrangement,  however,  the  nervous  system  differs 
but  little  except  in  the  quantity  of  neurine  composing  the  cerebral  gan- 
glia from  that  of  the  Nautilus,  as  will  be  apparent  by  turning  to  fig.  18, 
in  which  the  differences  between  them  are  exhibited  and  made  apparent 
to  the  eye.  In  fig.  18  the  bristle  is  placed  in  the  situation  of  the  oeso- 
phagus, around  which  the  nervous  masses  are  aggregated. 

*  Memoir  on  the  Pearly  Nautilus  (Nautilus  Pompilius,  Linn.),  by  Richard  Owen,  Esq.; 
published  by  direction  of  the  Royal  College  of  Surgeons  in  London,  1832. 

t  Descriptive  and  Illustrated  Catalogue  of  the  Physiological  Series  of  Comparative  Ana- 
tomy contained  in  the  Museum  of  the  Royal  College  of  Surgeons  in  London ;  Vol.  III.  Part 
I.  Nervous  System  and  Organs  of  Sense,  1835.  From  one  or  other  of  these  publications  the 
following  particulars,  and  the  figures  24  &  25,  are  entirely  derived. 


80 


COMPARATIVE   ANATOMY. 

Fig.  25. 


The  brain  and  origins  of  the  principal  nerves  of  a  Cuttle-fish  (Sepia  officinalis,  Linn.).  "The  bristle 
(10)  is  placed  in  the  situation  of  the  oesophagus,  around  which  the  nervous  masses  are  aggregated.  The 
Drain  and  optic  or  reniform  ganglions  are  here  developed  in  accordance  with  the  more  complex  organ  of 
Vision,  and  the  more  extensive  locomotive  faculties  of  this  higher-organized  Cephalopod.  A  small  spheri- 
cal body,  probably  analogous  to  the  corpus  geniculatum,  is  appended  to  the  peduncle  of  the  optic  ganglion 
on  either  side. 

"As  the  supra-cesophageal  cerebral  mass  is  principally  in  communication  with,  and  is  developed  to 
receive  the  impressions  transferred  by,  the  optic  nerves,  it  must  be  considered  as  analogous  to  the  bige- 
minal  bodies  in  the  brain  of  Vertebrata,  which  parts  are  first  developed  in  all  the  higher  classes,  and  from 
their  constancy  and  magnitude  in  the  cold-blooded  Vertebrata,  are  evidently  among  the  most  important 
parts  of  the  cerebral  organ.  The  medulla  oblongata,  from  which  the  auditory  and  respiratory  nerves  are 
given  off,  is  in  the  cuttle-fish  situated  below  the  oesophagus:  p.  The  cut  surface  of  the  cartilaginous 
cranium.  The  ganglion  stellatum  from  which  the  nerves  pass  to  the  soft  vascular  and  sensitive  external 
covering  of  the  Sepia." 

1.  The  brain,  corresponding  to  the  central  commissure  of  the  Nautilus.  2  2.  The  anterior  sub-cpsopha- 
geal  mass,  or  pes  anserinus,  giving  off  (5  5)  the  nerves  to  the  arms.  3  3.  The  great  reniform,  or  ophthal- 
mic ganglions.  4  4.  The  posterior  sub-oesophageal  mass  giving  off  (G  6)  the  nerves  to  the  cloak;  and  (8) 
the  nerves  to  the  viscera.  7  7.  The  ganglion  stellatum.  9  9.  Two  small  spherical  bodies  attached  to  the 
pedicles  of  the  ganglions.  10.  Bristle. 

"  As  the  supra-oesophageal  cerebral  mass,"  says  Mr.  Owen,  "  is  prin- 
cipally in  communication  with,  and  is  developed  to  receive  the  impres- 
sions transferred  by,  the  optic  nerves,  it  must  be  considered  as  analogous 
to  the  bigeminal  bodies  in  the  brain  of  Vertebrata  ;  which  parts  are  first 
developed  in  all  the  higher  classes,  and  from  their  constancy  and  magni- 
tude in  the  cold-blooded  Vertebrata,  are  evidently  among  the  most  im- 
portant parts  of  the  cerebral  organ."  A  small  spherical  body,  considered 
by  Mr.  Owen  as  probably  analogous  to  the  corpus  geniculatura,  is  ap- 
pended to  the  peduncle  of  the  optic  ganglion  on  either  side. 

"The  medulla  oblongata,  from  which  the  auditory  and  respiratory 
nerves  are  given  off,  is,  in  the  cuttle-fish,  situated  below  the  oesophagus. 

"  The  anterior  sub-cesophageal  ganglia  give  off  nerves  to  the  brachial 
and  labial  processes ;  the  posterior  sub-cesophageal  ganglia  send  off 
laterally  the  large  nerves  which  pass  outward  to  the  mantle,  and  then 
form  on  either  side  the  great  ganglion,  which,  from  the  radiated  distri- 
bution of  its  filaments,  is  termed  ganglion  stellatum."  In  addition  to 
these  there  are  a  pair  of  nerves  which,  like  those  in  the  Aplysia,  descend 
to  the  region  of  the  heart,  and  there  form  a  plexus  for  the  supply  of  the 
organs  of  digestion  and  circulation,  and  exhibit  a  very  perfect  analogy 
to  the  cardiac  and  solar  plexuses  of  the  sympathetic  nerve  in  man. 


CEPHALOPODA.  81 

This  very  general  review  of  the  nervous  system  in  these  two  members 
of  the  cephalopodous  class  of  Mollusca  shows  us,  in  the  first  place,  that 
the  supra-03sophageal  ganglion  in  the  Nautilus  has  no  cranial  cavity  con- 
structed for  its  protection,  and  that  instead  of  being  a  distinct  rounded 
mass,  as  in  the  Cuttle-fish,  it  seems  little  more  than  a  rounded  cord  or 
commissure  connecting  the  ophthalmic  ganglia,  and  placed  transversely 
to  the  oesophagus.  These  facts  by  themselves  would  be  of  little  value 
as  affording  data  for  reasoning  on  the  offices  and  relations  of  the  nervous 
system,  did  we  not  discover  this  comparative  imperfection  in  the  struc- 
ture of  their  brain  corresponding  with  imperfect  development  of  the 
organs  of  locomotion  and  sensation  generally.  The  peculiarities  in  the 
structure  of  the  Nautilus  are  in  complete  correspondence  with  this  prin- 
ciple. "  The  eye,"  observes  Mr.  Owen,  "  is  far  from  presenting  those 
complexities  of  structure  that  render  it  so  remarkable  an  organ  in  Dibran- 
ciate  Cephalopods.  Indeed,  it  here  appears  to  be  reduced  to  the  sim- 
plest condition  that  the  organ  of  vision  can  assume,  without  departing 
altogether  from  the  type  which  prevails  throughout  the  higher  classes. 
For  although  the  light  is  admitted  by  a  single  orifice  into  a  globular 
cavity  or  camera  obscura,  and  a  nerve  of  ample  size  is  appropriated  to 
receive  the  impression,  yet  the  parts  which  regulate  the  admission  and 
modify  the  direction  of  the  impinging  rays  are  entirely  deficient."  This 
state  of  the  eye  appears  to  be  in  harmony  with  the  habits  and  aptitudes 
of  the  animal  so  far  as  they  are  known.  On  the  other  hand,  the  superior 
locomotive  powers  of  the  cuttle-fish  demanding  more  perfect  vision,  we 
find  not  merely  the  eye  more  complex  and  perfect  in  its  construction, 
but  the  "  centre  to  which  the  impressions  of  the  optic  nerve  are  referred, 
more  highly  developed." 

In  fact,  as  Mr.  Owen  observes,  (p.  51),  "  The  inferiority  of  the  more 
intellectual  senses,  sight  and  hearing,  is  in  correspondence  with  the  sim- 
plicity of  the  brain.  If,  as  I  believe,  a  distinct  organ  for  the  latter  sense 
is  altogether  wanting,  the  Pearly  Nautilus  exhibits,  in  this  respect,  an 
obvious  approximation  to  the  inferior  Mollusks. 

"  As  the  Pearly  Nautilus,  like  the  latter  group  of  Mollusks,  is  also 
attached  to  a  heavy  shell,  and  participates  with  them  in  the  deprivation 
of  the  locomotive  instruments  of  the  Cephalopods,  we  may  thence  de- 
duce the  more  immediate  principle  of  their  reciprocal  inferiority  with 
respect  to  the  visual  organ  ;  for  what  would  it  avail  an  animal  to  discern 
distant  objects,  which  could  neither  overtake  them  if  necessary  for  food, 
nor  avoid  them  if  inimical  to  its  existence  ?" 

The  following  difference  in  the  distribution  of  the  nerves  of  the  Nau- 
tilus Pompilius  and  Sepia  offidnalls  is  alsd  highly  instructive. 

"In  those  Cephalopods,  whose  shells  are  rudimentary  and  internal, 
and  whose  bodies  are  enveloped  in  a  naked,  and,  as  we  may  suppose, 
sensible  mantle,  the  nerves  which  supply  that  part  radiate  from  a  gan- 
glion, which,  as  in  the  posterior  roots  of  the  spinal  nerves  in  the  Verte- 
brata,  is  interposed  on  the  cord  which  brings  them  into  communication 
with  the  central  mass.  In  the  Nautilus,  on  the  contrary,  whose  body  is 
incased  in  an  insensible  calcareous  covering,  the  analogous  nerves  are 
wholly  expanded  on  the  largely-developed  muscles  which  attach  the 
shell  to  the  body;  and  these  nerves,  like  the  motor  filaments  of  the 
6 


82  COMPARATIVE   ANATOMY. 

spinal  nerves,  pass  into  the  muscles  directly  from  the  brain  without  the 
interposition  of  any  such  ganglion. "* 

The  nervous  system  in  the  Myeloncephala,  or  vertebrated  class  of  ani- 
mals, which  derive  their  name  from  that  beautiful  piece  of  mechanism 
constructed  expressly  for  the  purpose  of  protecting  the  central  portions 
of  this  system,  will  next  engage  our  attention.  This  subkingdom  in- 
cludes Fishes,  Amphibious  animals,  Birds,  Reptiles,  and  the  Mammalia. 

In  these  animals  the  whole  skeleton  is  developed  in  relation  to  the 
nervous  system;  and  we  find,  as  might  be  expected,  the  axis  or  central 
portions  become,  by  an  increase  of  bulk  and  gradual  concentration  of 
parts,  more  decidedly  elevated  above  the  peripheral.  The  supra-03so- 
phageal  ganglion  now  having  an  appropriate  organ,  the  cranium  or  skull, 
for  its  protection,  uniformly  passes  by  the  name  of  brain  ;  while  the  re- 
maining ganglia  with  their  commissures  are  so  closely  united  that  all 
appearance  of  a  chain  is  lost,  and  one  nearly  uniform  cord  supplies  its 
place,  which,  from  the  situation  it  holds  in  relation  to  the  skeleton, 
namely,  within  the  spinal  column,  is  called  the  medulla  spinalis,  or 
spinal  cord. 

We  have  already  observed  in  some  of  the  Articulata  how  the  gradual 
union  of  several  ganglia  constitutes  a  tolerably  uniform  cord,  and  how 
also  the  addition  of  ganglia  to  the  single  pair  above  the  oesophagus 
which  we  saw  in  the  sandhopper,  so  far  increased  the  entire  mass  of 
neurine  in  that  situation  as  to  procure  for  it  the  title  of  cerebrum  or 
brain  ;  so  also,  even  in  the  Vertebrata,  whose  organs  of  sense,  the  instru- 
ments by  which  the  individual  is  brought  into  relation  with  the  external 
world,  are  so  much  more  perfectly  developed,  we  do  not  find  that  the 
brain  is  separated  from  the  spinal  cord  by  any  other  line  of  demarkation 
than  that  of  a  greater  disproportion  in  the  size  of  the  ganglia  composing 
it.  The  further  we  advance,  indeed,  we  meet  with  fresh  proofs  that 
the  brain,  even  of  the  highest  order  of  animals,  is  no  more  .than  a  series 
of  ganglia  or  collections  of  cineritious  neurine,  though  without  any  pecu- 
liar uniformity  of  size  in  which  the  nerves  from  the  different  organs  of 
sense  terminate,  and  from  which  the  nerves  of  volition  originate.  That 
these  ganglia  are  larger  and  more  numerous  at  the  anterior  than  at  the 
posterior  extremity  of  the  spinal  cord,  is  simply  in  accordance  with  the 
evident  marks  of  consummate  design  upon  which  every  living  being  has 
been  constructed  ;  for  all  the  organs  of  especial  sensation,  as  sight,  smell, 
hearing,  and  taste,  are  placed  in  that  situation  in  the  body  where  they 
have  the  greatest  range  for  the  exercise  of  their  powers, — either  in  that 
portion  which  is  in  advance  of  the  rest  of  the  animal  as  he  moves  over 
the  face  of  the  globe,  or,  as  in  man,  placed  so  completely  above  the  rest 
of  his  frame,  that  they  receive  no  impediment  from  it  in  the  performance 
of  their  functions.  These  organs,  from  the  high  office  they  have  to  fulfil 
in  the  sphere  of  animal  life,  appear  to  require  a  large  quantity  of  cineri- 
tious matter  to  accomplish  their  functions;  in  consequence  of  which  the 
anterior  extremity  of  the  spinal  cord  is  larger  than  the  posterior.  In  this 
simple  manner  may  we  account  for  the  relative  proportion  of  the  brain 
and  spinal  cord  throughout  the  vertebrated  class  of  animals  up  to  man 
himself. 

*  Memoir,  &c.,  p.  51. 


j  PISCES.  83 

In  Fishes  the  common  division  of  the  nervous  system  into  a  brain  and 
spinal  cord,  though  arbitrary,  it  is  nevertheless  convenient  to  retain. 
The  two  portions  in  fact  exhibit  but  a  slight  disproportion  in  general 
dimensions,  although  the  mass  of  the  spinal  cord,  as  a  whole,  is  very 
much  more  considerable  than  that  of  the  brain  or  cerebral  ganglia. 
Leuret  states  that  the  proportion  of  the  weight  of  the  brain  of  the  fish  to 
its  body  is  as  1  to  566  Ibs.* 

The  spinal  cord  in  fishes  bears  a  very  great  resemblance  to  that  of 
man,  differing  from  it  only  in  the  circumstance  that  the  superior  and  in- 
ferior grooves  which  separate  the  cord  into  two  lateral  portions  are  much 
deeper.  The  superior  groove,  indeed,  is  so  deep  that  it  forms  an  imper- 
fect canal,  the  internal  surface  of  which  is  covered  with  a  layer  of  gray 
matter.  This  canal  exists  in  the  human  foetus,  and  communicates  by 
the  calamus  scriptorius  with  the  fourth  ventricle,  which  in  reality  is 
nothing  more  than  a  permanent  dilatation  of  it.  In  the  interior  of  the 
cord  there  is  vesicular  neurine,  as  in  the  higher  animals,  but  there  is  so 
little  difference  of  color  that  it  easily  escapes  observation.  Under  the 
microscope  it  may  be  detected,  and  also  some  white  fibres  running 
through  it  at  a  right  angle.  These,  I  suppose,  are  the  excito-motory 
roots  of  the  spinal  nerves. 

The  spinal  nerves  arise  from  the  cord  in  fishes,  by  anterior  and  pos- 
terior filaments;  an  arrangement  similar  to  that  which  is  found  in  man, 
the  posterior  roots  having,  in  like  manner,  a  small  ganglion  connected 
with  them.  Mr.  Holmes  Coote,  in  his  prize  essay,  states  that  these 
ganglia  are  only  found  in  the  cartilaginous  fishes. 

The  form  of  the  cord  varies  in  the  different  kinds  offish  very  much  in 
correspondence  with  the  shape  of  their  bodies.  In  the  Tetrodon  Mola, 
a  short,  thick  fish,  the  spinal  cord  is  not  longer  than  the  encephalon  ;  in 
the  eel  it  is  long  and  thin ;  in  the  skate  it  is  slightly  enlarged  opposite 
the  large  pectoral  fins. 

The  cineritious  neurine  in  which  the  nerves  of  sense,  as  the  optic,  au- 
ditory, &c.,  in  the  Butterfly  and  Sepia,  terminate,  and  which  in  these 
animals,  when  fully  developed,  is  collected  into  one  rounded  mass,  the 
supra-02sophageal  ganglion,  in  the  fish  is  divided  into  several  separate 
masses,  so  that  almost  every  nerve  terminates  in  a  distinct  and  appro- 
priate ganglion  ;  hence  the  peculiar  appearance,  as  compared  with  that 
of  man,  which  the  brain  of  the  fish  presents. 

There  is  in  fact  no  set  of  organs  in  the  human  being  which  have  less 
resemblance  to  the  corresponding  ones  of  the  fish,  in  mere  external 
appearance,  than  the  masses  of  neurine  contained  within  the  cranium  ; 
and  I  will  venture  to  assert  that  there  are  few  circumstances  more  start- 
ling to  the  anatomist  who  has  confined  his  attention  solely  to  the  exami- 
nation of  the  human  brain,  than  the  first  appearance  which  the  brain  of 
a  large  fish  presents  to  his  view  on  removing  the  upper  surface  of  the 
skull.  Its  minuteness  as  compared  with  the  great  size  of  the  body,  the 
number  of  its  component  parts,  and  their  want  of  that  concentration 
which  is  so  peculiarly  striking  in  the  human  brain, — a  concentration,  let 
it  be  remembered,  deeply  interesting,  but  which  can  only  be  duly  appre* 

*  Anatomic  compare  de  systeme  nerveux  considered  dans  ses  rapports  avec  intelligence, 
par  Fr.  Leuret,  torn  i.  p.  164  (1839). 


84 


COMPARATIVE   ANATOMY. 


ciated  by  him  who  traces  with  attention  the  structure  of  the  nervous  sys- 
tem through  the  chain  of  beings, — all  give  a  mystery  and  confusion  to 
the  subject,  which  can  only  be  solved  by  seriously  considering  and  care- 
fully drawing  inferences  from  those  facts  which  rest  upon  comparative  as 
well  as  human  anatomy  for  their  support. 

Among  these  facts  there  are  none  more  important  to  us  than  these, 
viz. : — 

That  every  nerve  of  sense,  whether  it  be  of  the  sense  of  smell,  sight, 
hearing,  taste,  tact,  or  of  simple  sensation,  has,  at  its  central  extremity,  a 
collection  of  cineritious  neurine,  or  ganglion.  By  the  central  extremity 
of  a  nerve  we  mean  that  which,  in  the  ordinary  language  of  anatomists, 
is  called  the  origin  of  the  nerve,  but  which  in  strict  accordance  with  phy- 
siology ought  to  be  called  its  termination;  for  the  term  origin  is  not 
merely  incorrect  as  regards  the  function  of  the  nerves  of  sensation,  but 
also  as  regards  their  development ;  all  the  nerves  being  formed  in  the 
extremities  and  trunk  previous  to  their  connection  with  the  brain  and 
spinal  cord,  in  conformity  with  the  law  of  concentric  development,  or 
development  from  the  circumference  to  the  centre.  In  the  human  em- 
bryo, for  example,  we  find  that  when  the  nerves  first  engraft  themselves 
upon  the  spinal  cord,  the  external  layer  of  medullary  matter  is  extremely 
thin,  and  the  nerves  appear  to  be  simply  in  contact  with  the  cord,  but 
that  in  proportion  as  new  fibrous  layers  are  deposited,  the  nerve  is  en- 
veloped by  them,  and  becomes,  as  it  were,  dovetailed  into  the  fissures 
of  the  fibres. 

But  the  brain  of  fishes  does  not  consist  simply  of  ganglia,  in  which 
the  nerves  of  sensation  terminate  ;  there  are  other  parts  which  must,  I 
think,  be  viewed  as  a  decided  advancement,  in  accordance  with  their 
manifestation  of  higher  instinct  and  an  approach  to  the  intellectual 
faculties  of  memory  and  judgment.  These  parts  are  therefore,  in  all 
probability,  the  instruments  by  which  some  further  process  is  effected, 
approaching  in  its  nature  to  the  mental  operations  of  man,  such  as  judg- 
ment, of  course  extremely  limited  in  its  nature,  remembrance  of  sensa- 
tions, &c.  If  this  view  be  correct,  these  parts  must  be  analogous  to  the 
hemispheres  of  the  human  brain,  for  most  physiologists  of  the  present 
day  agree  with  the  opinion  given  by  M.  Cuvier,  in  his  report  to  the 
Academy  of  Sciences  at  Paris,  on  M.  Flourens'  work,  namely,  that  the 
cerebral  lobes  or  hemispheres  are  the  organic  parts  in  which  the  impres- 
sions made  on  the  organs  of  sight  and  hearing  become  perceptible  to  the 
animal,  and  that  probably  there  too  all  the  sensations  assume  a  distinct 
form,  and  leave  durable  impressions ;  that  the  hemispheres,  in  short,  are 
the  abode  of  memory,  and  from  this  circumstance,  therefore,  a  source  to 
the  animal  of  the  materials  for  judgment. 

Besides  these  parts,  which  in  all  probability  are  analogous  to  the 
hemispheres  of  the  human  brain,  there  is  a  structure  which  corresponds 
to  the  cerebellum.  Its  office  has  not  yet  been  clearly  ascertained,  though, 
for  reasons  to  be  mentioned  hereafter,  there  can  be  little  doubt  that  it  is 
in  some  way  or  other  connected  with  the  production  of  that  combined 
action  of  the  muscles  which  is  essential  to  progressive  motion,  and  which 
would  seem  to  require  appropriate  nervous  parts  for  its  direction  and 
control. 


PISCES.   ;<  85 

If  we  do  not  take  this  view  of  the  composition  of  the  brain  of  the 
fish,  we  must  remain  satisfied  with  the  obscurity  in  which  all  writers  on 
comparative  anatomy  have  left  this  subject,  and  be  content  to  see  the 
chain  of  progressive  development  from  the  lowest  animals  up  to  man, 
broken,  by  which  the  study  of  the  nervous  system  in  these  animals,  instead 
of  assisting  us  in  unravelling  the  structure  of  the  human  brain,  would 
only  plunge  us  into  fresh  difficulties.* 

Serresf  was  well  aware  of  the  backward  state  of  information  in  regard 
to  the  anatomy  of  the  brain  of  fishes.  He  thus  expresses  himself: — 

"  Considered  as  a  whole,  the  encephalon  of  the  fish  is  the  most  simple 
in  nature ;  it  is  the  most  complicated  in  our  writings ;  it  is  an  inextricable 
labyrinth  in  our  books.  Why  this  contradiction  between  nature  and  our 
writings  ?  There  exist  many  reasons  for  it  ;  the  principal  one,  that 
from  which  all  the  others  flow,  is  the  infinite  variety  which  the  brain  of 
the  fish  presents  to  our  notice.  Nature  seems  to  have  employed  all  her 
riches  on  these  animals.  Their  brain  varies  not  only  from  family  to 
family,  but  essentially  differs  from  genus  to  genus  ;  and  even  from  species 
to  species  there  is  continued  metamorphosis  going  on.  These  variations 
do  not  consist  solely  in  changes  of  form  of  position,  or  of  relation  in  the 
same  elements:  some  entire  parts  are  transformed,  left  out,  and  again 
reproduced." 

Notwithstanding  these  prefatory  observations  of  Serres,  I  confess  that 
he  does  not  appear  to  me  to  have  considered  the  structure  of  the  brain 
from  that  simple  point  of  view  from  which  I  consider  it  may  very  readily 
and  very  advantageously  be  regarded. 

One  reason  for  this  is,  that  in  most  of  his  descriptions  and  illustrations, 
he  omits  altogether  the  olfactory  tubercles,  unless  they  are  very  large, 
as  in  the  skates  and  sharks,  or  close  to  the  hemispherical  ganglia,  as  in 
the  eel ;  consequently,  repeatedly  confounds  the  two. 

Leuret  enumerates  eight  cerebral  ganglia:  1.  Olfactory;  2.  Cerebral ; 
3.  Optic ;  4.  Quadrigeminal ;  5.  Cerebellum ;  6.  Ganglia  of  the  tri- 
facial ;  7.  Ganglia  of  the  seventh  and  eighth  ;  8.  Those  which  exist 
at  the  base  of  the  brain  between  the  decussation  of  the  optic  nerves. 
Leuret  has  fallen  into  the  same  error  as  Serres :  for  instance,  he  states 
that  in  the  brain  of  the  codfish,  the  olfactory  ganglion  and  the  cerebral 
are  united  so  as  to  form  only  one,  and  in  Plate  II.  he  gives  the  brain  of 
the  codfish,  omitting  the  olfactory  ganglion  altogether,  and  calling  the 
hemispherical  ganglion,  " Tubercle  ethmoidal,  or  cerebral ;"  and  in  the 
figure  of  the  brain  of  the  eel,  where  the  olfactory  tubercle  is  so  close 
that  it  cannot  be  omitted,  he  then  designates  it,  "  Tubercle  ethmoidal;" 
and  the  hemispherical  ganglion,  "Tubercle  cerebral."  The  difference 
in  the  position  of  the  olfactory  ganglion  is  interesting,  but  it  does  not 
deprive  it  of  its  title  to  be  considered  as  a  portion  of  the  cerebral  mass. 

In  order  to  prove  the  correctness  of  this  view,  let  us  direct  our 
attention  to  a  few  specimens  of  the  brain  of  fishes,  commencing  with, 
the  more  simple  forms,  and  proceeding  gradually  to  the  more  compli- 

*  It  is  gratifying  to  the  author  to  find  that  this  view  of  the  homology  and  physiology  of 
the  cerebral  ganglia  of  the  fish,  which  was  first  enunciated  in  the  first  edition  of  this  work 
in  1836,  is  now  almost  universally  adopted. 

f  Anatomie  Comparee  du  Cerveau,  torn.  i.  p.  184. 


86 


COMPARATIVE    ANATOMY. 


Fig.  26. 


cated.     For  this  purpose   I  have,  intentionally,  selected  the  brains  of 
those  species  which  are  most  easily  obtained. 

But,  before  proceeding  to  the  description  of  the  brain  of  any  particular 
fish,  let  me  remark,  that  there  is  a  striking  peculiarity  in  the  brain-case  or 
cranium  of  fishes  as  regards  its  relation  to  the  dimensions  of  the  cerebral 
mass.  In  most  species  of  fishes,  the  cavity  of  the  skull  is  nearly  double, 
and,  in  many  instances,  nearly  treble,  the  size  of  the  included  brain. 
In  the  head  of  the  skate  and  cod,  this  difference  is  particularly  obvious: 
the  space,  which  is  left  between  the  surface  of  the  brain  and  the  walls  of 
the  cranium,  is  filled  up  with  a  loose  cellular  membrane  containing  a 
quantity  of  gelatinous  fluid,  and  evidently  answers  the  same  purpose  as 
the  arachnoid  in  those  instances  where  the  brain  is  closely  surrounded  by 
the  bones  of  the  skull.  In  the  sturgeon,  again,  there  is  no  such  vacancy 
— a  circumstance  which  it  is  important  to  bear  in  mind,  in  order  to  avoid 
injuring  the  brain  when  opening  the  skull  of  this  cartilaginous  fish. 

The  brain  of  the  whiting,  haddock,  and  the  cod,  are  exactly  alike. 
The  whiting  has  been  selected,  because  its  skull  is  soft  and  easily  opened. 
The  skull  of  the  codfish,  which  are  brought  to  London,  is  almost  al- 
ways fractured  and  the  brain  injured.  The  fishermen  always  stun  them 
by  a  blow  on  the  head.  The  student,  before  he  removes  the  brain,  had 
better  study  fig.  26 :  else,  he  will  commit  the  same  error  which  Serres 
and  Leuret  have  done,  and  some  physiological  writers,  who  have  copied 
their  plates  without  dissecting  the  fish,  and  describe  the  termination  of 
the  olfactory  commissures  in  the  hemispheres  as  the  olfac- 
tory ganglia ;  as  they  either  leave  them  in  the  skull,  when 
they  remove  the  brain,  or,  if  they  examine  the  brain  in  situ, 
they  neglect  to  uncover  the  ganglia. 

The  whiting. — If,  in  this  fish,  we  view  the  cerebral  mass 
from  above,  proceeding  from  before  backwards,  we  observe 
three  rounded  masses  or  nodules  of  neurine,  and  a  triangu- 
lar shaped  medullary  leaflet,  which  overlaps  that  fissure  of 
the  cord  called  the  fourth  ventricle. 

The  first  pair  are  the  olfactory  ganglia,  lying  on  the  crib- 
riform plate  of  the  ethmoid  bone,  where  they  are  joined 
by  the  olfactory  nerves,  as  they  are  in  man.  They  are 
about  the  size  of  large  pins'  heads,  and  their  being  situated 
at  some  distance  from  the  rest  of  the  cerebral  mass,  is,  I 
suppose,  the  reason  they  have  escaped  the  observation  of 
most  anatomists,  and  are  not  included  by  Serres  in  his  de- 
scription of  the  component  parts  of  the  brain  in  this  fish. 
iory  ganglion.  B.  To  me  they  nevertheless  appear  to  be  as  decidedly  a  portion 
fop-  of  the  cerebral  mass  as  the  optic  tubercles  or  ganglia,  in 
which  the  optic  nerves  terminate,  and  which  are  always  in- 
cluded in  the  description  of  the  fish's  brain.  The  commis- 
sure or  apparatus  of  union  which  connects  this  ganglion  with  the  rest  of 
the  encephalon  is  thin  and  thread-like,  resembling  a  nerve  in  its  appear- 
ance, and  about  an  inch  in  length.  Some  authors  have  stated  that  the 
olfactory  tubercles  in  the  osseous  fishes  are  generally  in  contact  with  the 
cerebral  mass ;  but  the  brain  of  the  whiting,  as  well  as  of  many  others, 
forms  an  exception  to  the  rule.  The  next  masses,  about  the  size  of  a 


Brain  of  the 
•whiting  the  size 
of  life,  seen  on 
its  upper  sur- 
face. A.  Olfac- 


,,  PISCES.  87 

small  pea,  are  analogous  to  the  human  hemispheres,  and  may  be  desig- 
nated the  hemispherical  ganglia :  they  are  connected  together  by  a 
transverse  commissure,  the  anterior  commissure.  It  is  particularly  in- 
teresting to  observe  how  closely  these  hemispherical  ganglia  of  the 
whiting  correspond  with  the  cerebral  hemispheres  of  the  human  embryo 
at  the  seventh  week.  These  bodies,  however,  are  described  by  Tiede- 
mann*  as  analogous  to  the  corpora  striata  rather  than  to  the  hemispheres 
of  the  brain,  and  by  Desmoulins  to  the  optic  thalami.  With  all  defer- 
ence to  the  talented  authors  of  these  opinions,  I  must  say  that  I  do  not 
imagine  either  of  these  analogies  to  be  founded  in  fast.  The  corpora 
striata  and  optic  thalami  in  man  and  the  Mammalia,  are  structures  formed 
so  entirely  of  fibres  intermingled  with  cineritious  neurine,  either  termi- 
nating in,  or  arising  from,  the  hemispheres,  that  I  cannot  conceive  how 
they  should  exist  if  the  hemispheres  themselves,  from  which  they  derive 
their  origin,  and  in  which  they  terminate,  were  altogether  absent. 

Nevertheless  it  is  not  true,  as  some  authors  have  stated,  that  these 
ganglia  always  hold  an  exact  relative  size  to  the  hemispherical  ganglia. 

The  next  pair  of  nodules  are  the  optic  ganglia  or  tubercles,  analogous 
to  the  tubercula  quadrigemina  in  man.f 

Leuret  does  not  employ  the  term  optic  lobes  as  synonymous  with 
tubercula  quadrigemina,  which  most  anatomists  of  the  present  day  agree 
in  considering  the  true  optic  tubercles. 

*  Tiedemann  on  the  Foetal  Brain ;  translated  by  Bennet,  p.  230. 

f  By  the  translator  of  Carus's  Comparative  Anatomy  (Mr.  R.  T.  Gore)  it  is  said,  in  page 
240,  that  the  identity  of  these  middle  cerebral  masses  with  the  corpora  quadrigemina  is 
fully  proved  by  a  reference  to  the  progress  of  formation  of  the  same  parts  in  the  fostus  of 
man  and  other  Mammalia.  In  the  early  periods  of  the  existence  of  the  human  fetus,  the 
corpora  quadrigemina  contain  a  capacious  ventricle,  subsequently  filled  up  by  the  deposition 
of  nervous  matter,  so  as  to  leave  only  the  narrow  passage  known  as  the  aqueduct  of  Syl- 
vius. This  ventricle  is  covered  over  by  two  thin  medullary  lamina?,  in  contact  with  each 
other,  though  not  united,  along  the  mesial  line,  and  contains  elevations  or  ganglia  similar  to 
those  here  described.  (Tiedemann,  I  c.,  186.)  According  to  him,  however,  they  represent 
not  merely  the  anterior,  but  rather  both  pairs  of  the  corpora  quadrigemina.  Their  size  is 
directly  proportioned  to  that  of  the  eyes  and  optic  nerves,  being  small  in  the  conger  eel  and 
burbot,  of  moderate  size  in  rays  and  sharks,  and  considerably  larger  than  the  first  cerebral 
mass  in  the  trout,  pike,  garpike,  salmon,  carp,  uranoscopus,  sparus,  scorpoene,  perch,  &c.  In 
the  genera  Sparus,  Scorpaena,  Clupea,  Mugil,  Scomber,  Zeus,  Trigla,  &c.,  the  optic  nerve, 
arising  on  each  side  from  the  middle  cerebral  mass  or  optic  tubercles,  consists  of  a  membran- 
ous expansion,  disposed  in  longitudinal  folds  like  the  leaves  of  a  closed  fan,  though  in- 
closed within  a  cylindrical  neurilemma,  which,  however,  adheres  so  loosely  as  to  allow  the 
folds  to  glide  one  upon  another.  In  the  Trachinus  Draco,  where  the  diameter  of  the  nerve 
is  about  a  line,  there  are  nine  or  ten  folds,  which,  when  expanded,  form  a  membrane 
nerve  is  almost  in  a  rudimentary  state,  its  length  and  the  thickness  of  the  neurilemma  being 
eighteen  or  twenty  lines  wide.  In  the  pleuronectes,  mursenae,  rays,  sturgeons,  &c.,  the  optic 
proportionally  very  considerable.  In  a  sturgeon  four  feet  long,  the  diameter  of  the  nerve 
was  not  above  three-fourths  of  a  line,  and  the  medullary  matter  contained  within  it  less  than 
one-fourth  of  the  whole,  the  rest  being  formed  by  neurilemma.  In  the  Ammocetus  the  nerve 
is  wanting,  though  there  is  a  rudiment  of  the  eye.  (Desmoulins,  /.  c.,  p.  325,  &c.)  In  the 
Cydopterus  Lumpus,  the  nerve  on  each  side  consists  of  from  twenty-five  or  thirty  parallel 
filaments,  each  covered  by  a  separate  neurilemma,  and  collectively  inclosed  within  a  common 
cylindrical  sheath  so  loosely  as  to  allow  of  motion  one  upon  the  other.  The  most  remark- 
able circumstance,  however,  is  that  the  cerebral  termination  of  each  nerve  is  continuous  with 
that  of  the  other ;  the  extremity  of  the  neurilemma  of  each  filament  and  the  ends  of  the  com- 
mon sheath  of  each  inosculating,  as  it  were,  together.  The  point  of  union  of  the  common 
sheaths  of  the  filaments  of  each  side  is  connected  with  the  brain  merely  by  very  fine  cellu- 
lar tissue,  without  the  interposition  of  any  medullary  matter,  and  so  loosely  as  to  admit  of 
being  separated  by  the  least  eifort.  {Desmoulins.,  I  c.t  330,  Plate  IX.  fig.  3.)  The  nerves  in 
this  case  do  not  decussate. 


88 


COMPARATIVE   ANATOMY. 


These  are  his  words  :*  "Optic  Ganglia. — Haller,  Vic  d'Azyr  and  Ca- 
rus,  have  called  them  thalami  optici ;  Camper,  cerebral  hemispheres ; 
Scarpa,  great  tubercles  of  the  brain  ;  Treviranus,  posterior  hemispheres; 
Cuvier,  hollow  lobes;  M.  Serres,  M.  Desmoulins,  M.  Gottsche,  optic 
lobes.  In  some  fish,  in  which  the  optic  ganglia  are  the  largest,  there  is 
always  that  white  appearance  which  belongs  to  a  medullary  substance. 
In  osseous  fishes  they  are  always  uncovered  ;  in  the  skate  and  the  shark 
there  is  a  portion  concealed  by  a  prolongation  of  the  cerebellum.  At 
first  sight,  and  especially  if  examined  after  being  in  spirit,  their  appear- 
ance is  throughout  the  same,  but  in  a  fresh  state  we  can  trace,  upon  the 
internal  and  superior  surface,  one  of  the  roots  of  the  optic  nerve  ;  and 
upon  the  external  inferior  surface  a  second  root  of  the  same  nerve. 
They  are  in  exact  proportion  to  the  size  of  the  eyes:  Gottsche  has  ob- 
served in  those  which  have  the  eyes  of  unequal  size,  in  the  Pleuronectes, 
for  example,  sole,  turbot,  &c.,  that  the  optic  lobes  are  unequally  deve- 
loped. If  we  divide  these  lobes,  we  see  that  they  do  not  constitute 
really  a  ganglion,  but  that  they  are  formed  by  a  very  fine  fibrous  lamina. 
The  optic  laminae  on  one  side  is  adherent  on  the  internal  surface  to  the 
corresponding  laminaB  on  the  opposite  side,  and  at  the  point  of  this  adher- 
ence it  consists  of  fibres  which  run  from  right  to  left :  these  fibres  form 
there  a  true  commissure,  and  represent  the  corpus  callosum,  as  we  shall 
see  presently.  The  optic  laminae  form  the  walls  of  a  double  ventricle, 
separated,  the  right  from  the  left,  by  a  small  lamina  analogous  to  the  in- 
terventricular  lamina  or  septum  lucidumof  superior  animals.  The  inte- 
rior of  these  ventricles  presents  different  appearances,  according  to 
whether  it  belongs  to  an  osseous  or  cartilaginous  fish.  In  the  former, 
we  perceive  first  a  white  commissure  which  unites  the  anterior  portion 
of  the  two  optic  lobes  ;  behind  this  commissure,  the  anterior  prolonga- 
tions of  the  spinal  cord,  which  is  found  below  all  the  cerebral  ganglia, 
to  which  they  serve  as  the  base,  leaving  between  them  the  infundibulum 
or  lower  part  of  the  third  ventricle  of  the  mammiferaB  ;  behind  the  infun- 
dibulum, another  or  posterior  commissure,  analogous  to  the  preceding; 
at  length,  above  this  commissure,  a  tubercle,  flattened,  bilobed,  fur- 
nished with  two  long  appendages  of  a  medullary  substance  of  a  whitish 
gray.  The  bilobed  tubercle  represents  the  tubercula  quadrigemina,  and 
below  is  the  aqueduct  of  Sylvius,  which  forms  a  communication  between 
the  cavity  of  the  optic  ventricles  and  another  ventricle  placed  under  the 
cerebellum.  On  each  side,  the  ventricle  of  the  optic  lobe  presents  a 
small  tubercle  (tori  semicirculares  of  Haller,  the  semicircular  collar  of 
Cuvier,  the  anterior  internal  ganglions  of  Carus),  which  is  analogous  to 
the  corpus  striatum." 

"  In  cartilaginous  fish,  the  cavity  formed  by  the  optic  lamina  does 
not  present  any  commissure,  nor  the  tubercular  quadrigemina  very  dis- 
tinctly, but  only  the  infundibulum  and  the  commencement  of  the  aque- 
duct of  Sylvius."t 

M.  Serres  thus  describes  the  optic  tubercles  in  fish,  considering  them 
analogous  to  the  tubercula  quadrigemina  in  man.  His  words  are, — 
"  Thus  we  see  the  tubercula  quadrigemina  exist  in  osseous  fish:  they 
are  in  direct  communication  by  their  posterior  extremity  with  the  cere- 

*  Op.  cit.,  p.  140.  *  P.  142,  op.  cit. 


PISCES.  89 

bellum,  and  there  is  a  true  processus  e  cerebello  ad  testes:  by  their  an- 
terior part  they  are  continued  into  a  long  lamina,  which  curves  upon 
itself,  and  covers  a  large  portion.  When  we  examine  the  brain  of  the 
carp,  we  see  behind  and  within  these  optic  ganglia  two  oblong  bodies, 
which  are  nothing  but  the  folded  extremity  of  these  lamina?." 

The  next  division  of  the  whiting's  brain  is  the  triangular  leaflet,  the 
analogue  of  the  cerebellum  or  little  brain  in  man.  These  parts  comprise 
the  whole  of  the  nervous  masses  which  can  be  observed  by  merely  look- 
ing upon  the  upper  surface  of  the  cerebral  mass  of  the  whiting;  but  if 
we  raise  the  optic  tubercles,  we  find  that  instead  of  their  being  solid,  as 
they  appear,  they  are  hollowed  out  internally  :  and  by  turning  them  back, 
we  observe  two  small  rounded  projections,  which  appear 
to  be  merely  continuous  portions  of  the  same  ganglia,  Fig.  27- 
bearing  some  resemblance  to  the  posterior  of  the  quadri- 
geminal  bodies  called  the  testes  in  the  human  subject. 
By  raising  the  cerebellum  we  also  observe  that  the  spinal 
cord  lying  beneath  it  is  much  thicker  than  the  same  part 
lower  down  ;  in  fact,  that  fresh  neurine  has  been  added 
to  it  on  each  side,  in  the  shape  of  two  oval  bodies,  the 
nature  of  which,  or  the  analogy  they  bear  to  particular 
portions  of  the  human  brain,  it  is  not  easy  to  discover  in 
the  whiting;  but,  as  will  be  seen  afterwards  by  reference 
to  other  fishes,  it  is  highly  probable  that  they  correspond  Brain  of  the 
to  the  posterior  pyramidal  bodies  or  auditory  ganglia,  to-  ^beiE  **£&£ 
gether  with  the  ganglia  of  the  pneumogastric  nerves  in  SeTrlnchio^ 
man,  the  branchiogastric  nerve  in  the  fish  taking  its  rise  trie  ganglia  °dis- 
from,  or  being  in  direct  communication  with,  them.  p  Eycerebeiium. 


If  the  whole  encephalic  mass  of  the  whiting,  having  £- 
been  removed  from  the  skull,  be  reversed,  and  the  under 
surface  exposed,  two  oval-shaped  cineritious  bodies  may  be  observed. 
u  These  bodies,"  says  Spurzheim,*  c<  probably  correspond  to  the  gray 
tubercle  (tuber  cinereum)  of  Mammalia.  This  tubercle,  in  ttie  higher 
classes  of  animals,  always  sends  fibres  to  the  optic  nerves,  which,  after 
this  accession,  advance  in  their  course  of  increased  size."  Carus  enter- 
tained the  same  opinion,  while  Cuvier  regarded  them  as  the  true  optic 
tubercles.  The  use  of  the  tuber  cinereum  in  man  certainly  has  not  yet 
been  ascertained;  but  it  is  much  more  probable  that  these  oval-shaped 
cineritious  bodies  of  the  fish  are  analogous  to  them,  than  to  the  corpora 
mammillaria,  as  conjectured  by  Serres;  for  the  corpora  mammillaria 
being  portions  of  the  fornix  in  man,  cannot  be  supposed  to  exist  where 
that  structure  is  wanting,  as  it  is  in  the  fish. 

The  brain  of  the  cod  so  closely  resembles  that  of  the  whiting  that  it 
will  not  require  any  particular  description  ;  but  I  have  introduced  a  draw- 
ing (after  Serres),  to  show  the  optic  ganglia  turned  back  (fig.  28),  exhi- 
biting the  connection  of  the  olfactory  nerves  with  the  hemispherical 
ganglia,  and  with  the  continuous  fibres  of  the  spinal  cord. 

The  Carp  (fig.  29).  —  On  first  exposing  the  brain  of  the  carp,  we  are 
struck  with  the  great  dissimilarity  which  it  presents  to  that  of  the  species 

*  Anatomy  of  the  Brain,  1826,  p.  38. 


90  COMPARATIVE   ANATOMY. 

of  fish  last  described.     Instead  of  only  four  divisions,  we  here  distinctly 
observe  no  fewer  than  seven.     A  little  consideration,  however,  will  con- 
Fig.  28.  Fig.  29. 


Fig.  28. — (From  Serres'  Anatomie  Comparge  du  Cerveau.)  The  brain  of  the  codfish,  unfolded  to  expose 
the  continuation  of  the  spinal  cord  and  its  connection  with  olfactory  nerves.  B.  Hemispherical  ganglion. 
c.  Optic  ganglion.  E.  Cerebellum.  H.  Spinal  cord.  m.  Corpus  striatum. 

Fig.  29.— -Brain  of  the  carp,  removed  from  the  skull,  and  seen  from  above.  A.  Olfactory  ganglion.  B. 
Hemispherical  ganglion,  c.  Optic  ganglion.  D.  Testes,  or  posterior  optic  ganglion.  K.  Cerebellum.  F. 
Auditory  ganglion.  G.  Pneumogastric  ganglion.  H.  Spinal  cord.  j.  Pituitary  gland.  M.  Corpus 


vince  us  that  there  is  no  essential  difference  between  the  brain  of  the 
whiting  and  that  of  the  carp,  but  that  the  analogy  is  perfect  and  the  chain 
of  structural  uniformity  yet  unbroken.  The  first  pair  of  nodules,  which 
are  small,  are  the  olfactory  ganglia,  and,  like  those  of  the  whiting,  situ- 
ated on  the  ethmoid  bone,  at  some  distance  from  the  remainder  of  the 
encephalon.  The  commissure  connecting  them  in  a  carp  seven  inches 
in  length  was  a  little  more  than  an  inch  long.  The  second  pair  are  the 
cerebral  hemispheres,  but  extremely  small  as  compared  with  the  same 
parts  in  the  cartilaginous  fishes.  The  third  and  fourth  divisions  evidently 
belong  to  the  optic  ganglia,  and  not  to  the  hemispherical,  for  we  find  the 
pineal  gland  situated  between  the  two.  The  optic  ganglia  are  hollow 
in  all  fish,  as  we  have  seen  in  the  cod,  but  in  the  carp  the  covering  is 
imperfect,  as  we  see  in  fig.  29,  representing  the  brain  as  seen  from  above: 
letter  c  runs  to  this  lamina,  and  D  to  the  internal  portion.  At  the  base 
of  the  brain  may  be  observed  a  large  pituitary  gland  and  infundibulum. 
The  cerebellum  is  the  next  mass,  and  immediately  behind  it  are  the 
auditory  ganglia,  analogous  to  the  posterior  pyramidal  bodies  in  man. 
On  each  side  of  these  ganglia  are  placed  those  bodies  from  which  the 
branchiogastric  nerves  arise,  analogous  to  the  pneumogastric  ganglia, 
which  are  placed  to  the  inner  side  of  the  restiform  bodies  in  the  human 
subject.  These  bodies  are  stated  by  Cruveilhier*  to  be  of  enormous  size 
in  the  Electric  Ray,  in  whom  the  branchiogastric  nerve  is  so  amazingly 

*  Op.  cit. 


PISCES. 


91 


The  brain  of  the  eel. 
seen  from  above.  A. 
Olfactory  ganglion.  B. 
Hemispherical  gangli- 
on, c.  Optic  ganglion. 
E.  Cerebellum.  H.  Spi- 
nal cord. 


Fig.  31. 


developed.  The  hemispheres,  though  solid,  consist  of  Fig.  30. 
two  portions,  the  exterior  or  cortical  substance,  the 
hemispherical  ganglia,  and  a  bed  of  vesicular  neurine 
in  the  centre,  through  which  white  fibres  of  the  cord 
may  be  seen  spreading  towards  the  circumference, 
separated  from  each  other  by  gray  neurine. — (See  fig- 
30.)  It  is  identical  with  the  corpus  striaturn  of  the 
human  brain. 

In  the  common  eel  we  have  an  appearance  of  va- 
riety, which  simply  arises  from  the  circumstance  of  the 
olfactory  tubercles  (which  in  the  whiting,  carp,  &c., 
are  situated  on  the  cribriform  plate  of  the  ethmoid 
bone,  at  the  distance  of  nearly  an  inch  from  the  rest 
of  the  cerebral  mass)  being  placed  close  to  the  hemi- 
spheres ;  this,  and  also  their  being  slightly  grooved 
transversely  on  their  upper  surface,  gives  to  the  whole  cerebral  mass 
the  appearance  of  a  long  chain  of  tubercles,  which  have  no  resem- 
blance to  the  component  parts  of  the  brain  in  the 
last-mentioned  fish,  so  that  there  appears  at  first  sight 
to  be  no  analogy ;  the  number  of  essential  parts  is, 
however,  in  reality  the  same,  and  the  analogy  between 
them  perfect ;  the  only  real  difference  consists  in  their 
relative  size  and  the  distance  at  which  they  are  situated 
from  one  another. — (Fig.  30.) 

In  the  pike,  also,  the  olfactory  ganglia  are  placed 
close  to  the  hemispherical,  and  if  the  olfactory  nerves 
are  traced  to  the  nose,  they  will  be  seen  dividing  into 
several  branches,  but  without  forming  any  bulbous 
enlargement,  passing  through  a  membrane  which  cor- 
responds to  the  cribriform  plate  of  the  ethmoid. — (See 
fig.  31.) 

In  the  cartilaginous  fishes  the  form  of  the  brain  ap- 
proaches so  much  more  nearly  to  that  of  the  higher 
orders  of  animals,  that  at  first  sight  the  cerebral  mass 
in  one  of  the  Rays,  as  the  common  skate  (figs.  32  and 
33),  appears  to  differ  essentially  in  its  component  parts 
from  that  of  one  of  the  bony  fishes  which  we  have 
hitherto  been  describing  particularly.  There  is,  how- 
ever, no  essential  distinction;  the  difference  arising 
solely  from  the  greater  concentration  of  similar  or 
nearly  similar  parts. 

The  olfactory  ganglia  in  the  skate  are  extremely 
large,  as  will  be  seen  by  referring  to  the  diagram  (fig. 
32).  The  peduncles  are  long,  and  the  cerebral  hemi- 
spheres form  a  more  considerable  mass,  slightly  irregu- 
lar upon  its  surface,  and  thus  assuming  an  approach 
to  a  convoluted  arrangement  of  the  superficies.  These 
hemispheres  are  solid,  as  we  have  seen  in  the  carp  ; 
the  white  fibres  may  be  seen  entering  at  the  posterior 
extremity,  and  separated  by  gray  neurine  in  like  man- 


Brain  of  the  pike.  A. 
Olfactory  ganglion.  B. 
Hemispherical  gan- 
glion, c.  Optic  gan- 
glion. E.  Cerebellum. 
H.  Spinal  cord.  x.  The 
olfactory  nerve  pene- 
trating the  cribriform 
plate  of  ethmoid  bone, 
without  any  bulbous  en- 
largement. 


92 


COMPARATIVE   ANATOMY. 


The  brain  of  the  skate,  removed  from  the 
skull,  and  seen  from  above.  A.  Olfactory 
ganglion.  B.  Hemispherical  ganglion,  c.  Op- 
tic ganglion.  E.  Cerebellum.  G.  Pneumo- 
gastric  ganglion. 


32-  ner.     The  optic  tubercles  have  also 

increased  in  size,  and  are  connected 
with  the  hemispheres  by  distinct  me- 
dullary bands. 

But  the  cerebellum  is  found  to  have 
undergone  the  greatest  alteration  of 
any  part ;  for  it  is  no  longer  a  mere 
triangular  leaflet,  but  is  divided  into 
lobes,  and  partly  overlaps  the  optic 
tubercles.  But  the  hemispherical  gan- 
glia are  not  yet  separated  from  the  cor- 
pora striata  by  any  interspace  or  ven- 
tricle. This  covering  is  first  found  in 
the  sharks.  The  transverse  commis- 
sure is  very  distinct  (see  fig.  32). 

In  the  sharks,  the  cerebellum  is 
much  larger  and  more  complicated 
than  in  any  other  fish.  It  very  much 
resembles  that  of  the  bird,  consisting 
of  transverse  lamina?. 

The  advance  in  the  size  and  com- 
plexity of  the  cerebellum  is  interesting 
when  we  remember  the  great  locomo- 
tive powers  of  these  fish ;  and  the  fact  that  they  are  entirely  dependent 
on  these  powers,  not  merely  for  locomotion,  but  for  their  buoyancy,  for 
they  do  not  possess  any  air-bag,  like  the  osseous  fishes. 

On  each  side  of  the  cerebellum  in  the  skate  there  is  an  extensive 
layer  of  folded  neurine,  from  which  a  considera- 
ble portion  of  the  branchiogastric  nerve  arises. 
It  is  the  analogue  of  the  respiratory  ganglia  in 
the  Mollusca,  &c.,  and  the  pneumogastric  or 
restiforra  ganglia  in  man ;  we  shall  also  find  a 
portion  of  the  nerve  corresponding  to  the  fifth 
nerve  of  Mammalia  connected  with  it  (G).  Leuret 
describes  it  as  partly  the  branchiogastric  gan- 
glion and  partly  a  ganglion  of  the  fifth  pair.  Serres 
considers  this  structure  as  forming  a  portion  of 
the  cerebellum.  Spurzheim  does  not  agree  with 
him,  though  he  does  not  form  the  same  conclusion 
which  I  have  done. 

On  reversing  the  position  of  the  brain  (fig.  33), 
we  observe  the  two  small  tubercles  (i)  of  medul- 
lary neurine,  believed  to  be  analogous  to  the 
tuber  cinereum  in  man,  a  part  whose  character, 
as  before  stated,  has  not  yet  been  ascertained.  I 
am  glad  to  find  that  Leuret  agrees  with  the  view 
of  the  horaology  of  these  ganglia,  which  I  enunci- 
ated in  my  first  edition.  The  pituitary  gland  (j) 
is  large  in  this  fish,  and  seen  distinctly  in  fig.  33. 
From  the.  Fish,  let  us  direct  our  attention  to 


Fig.  33. 


Brain  of  the  skate  seen  on 


REPTILIA. 


93 


some  specimens  of  the  cerebro-spinal  axis  in  Amphibia.    The  most  fami- 
liar example  of  this  class  is  our  common  frog. 


Fig  34. 


C&D 


Side  view  of  the  brain  of  the  frog.  A.  Olfactory  gang-lion.  B.  Hemispherical  ganglion,  c  &  D.  Optic 
ganglion. — When  c  and  D  occur  in  the  same  figure,  c  signifies  anterior  optic  ganglion.  E.  Cerebellum. 
H.  Spinal  cord.  R.  Pineal  gland. 

In  this  animal  the  olfactory  ganglia  are  brought  close  up  to  the  hemi- 
spheres, as  in  the  eel  (see  fig.  30)  instead  of  being  at  some  distance, 
and  connected  by  long  peduncles,  as  in  most  other  fish.  The  hemi- 
spheres (B),  larger  in  proportion  than  in  fish,  are  nearly  double  the  size 
of  the  optic  ganglia.  They  are  hollow,  and  contain  within,  a  distinct 
corpus  striatum,  or  anterior  cerebral  ganglion,  which  will  be  better  seen 
and  better  understood  in  the  classes  above  the  Amphibia.  The  optic 
ganglia  (c  and  D)  are  distinct,  and  covered  with  a  dark  membrane. 
The  pineal  gland  is  small  but  distinct.  The  cerebellum  is  peculiarly 
small,  forming  only  a  narrow  tongue  across  the  posterior  surface  of  the 
cord.  This  simple  form  of  cerebellum,  according  to  Leuret,  exists  also 
in  the  toad,  lizard,  terrestrial  salamander,  snake,  and  newt. 

The  pneumogastric  and  auditory  ganglia  do  not  project  on  the  surface, 
but  ganglionic  neurine  may  be  seen  in  their  usual  situation,  when  a 
transverse  section  is  made  of  the  medulla  oblongata. 

Reptilia. — From  this  class  we  may  select  the  turtle :  specimens  are 
easily  procured,  and  its  brain  is  extremely  simple  (fig.  35).  The  olfac- 
tory ganglia,  instead  of  being  situated  on  the  cribriform  plate  of  the  eth- 
moid bone,  are  placed,  as  in  the  eel,  almost  close  to  the  hemispheres, 
and  the  commissures  connecting  them  are  therefore  extremely  short: 
they  communicate  internally  with  the  ventricles.  The  olfactory  nerves 
pass  towards  the  cribriform  plate  of  the  ethmoid,  but  there  is  no  bulbous 
enlargement  at  that  spot.  They  split  into  small  filaments,  which  pass 
through  separate  foramina.  The  cerebral  lobes  or  hemispheres  are  larger 
and  more  perfectly  developed  than  in  the  Amphibia  or  in  any  of  the 
finny  tribes. 

Fig.  35. 


Side  view  of  the  brain  of  the  turtle.    A.  Olfactory  ganglion.    B.  Hemispherical   ganglion,    c.  Optic 
ganglion.    E.  Cerebellum.    G.  Pneumogastric  ganglion.    H.  Spinal  cord,    j    Pituitary  gland. 

These  ganglia  are  hollowed,  and  when  opened  (see  fig.  36)  the  corpus 
striatum  or  anterior  cerebral  ganglion  (M)  may  be  seen  :  it  is  of  large 
size.  A  section  of  this  ganglion  exhibits  a  striated  appearance  very 


94 


COMPARATIVE   ANATOMY. 


Fig.  36. 


sirailiar  to  that  in  the  human  being;  posterior  and  external  to  the  ven- 
tricle is  another  enlargement  (K),  which  I  suppose  is  the  analogue  of 
the  thalamus  or  posterior  cerebral  ganglion. 

Leuret  designates  this  enlargement  in  the 
ventricle  of  the  turtle  the  corpus  striatum,  but 
he  says  nothing  of  the  smaller  projection  just 
exterior  to  it,  and  anterior  to  the  optic  ganglia. 
The  optic  tubercles  are  placed  immediately 
behind  the  optic  thalamus.  The  hemispheres 
are  joined  to  the  cerebellum  by  two  medullary 
processes,  the  analogues  of  which,  in  the  hu- 
man brain,  are  called  the  processes  e  cerebello 
ad  testes;  and  as  these  parts  form  a  commissure 
between  the  anterior  portion  of  the  cerebral 
mass  and  cerebellum,  I  have,  in  my  description 
of  it  in  the  human  brain,  called  it  the  inter- 
cerebral  commissure.  It  is  from  this  part  that 
the  fourth  pair  of  nerves  arise  both  in  man,  and 
the  Vertebrata  generally.  Between  the  opticle 
tubercles  and  the  hemisphere  is  the  pineal 
gland,  of  an  elongated  form,  soft,  consisting 
only  of  blood-vessels. 

The  cerebellum  (E)  of  the  turtle,  though 
distinctly  formed,  is  small,  and  consisting  of 
a  single  lamina.  It  is  smooth  and  convex 
above,  and  hollowed  below,  and,  with  a  slight- 
ly pointed  extremity,  covers  in  the  posterior 
fissure  of  the  cord.  The  auditory  ganglia  and 
respiratory  ganglia  are  scarcely  perceptible. 
The  first  circumstance  is  accounted  for  by  the 
sense  of  hearing  in  these  animals  not  being 
acute  ;  in  fact,  all  their  sensations  are  pecu- 
liarly dull,  and,  in  the  second  place,  the  "be- 
soin  de  respirer,"  as  the  French  express  it,  is 

not  the  violent,  uncontrollable  sensation  which  is  evidently  experienced 
by  fishes,  and  the  higher  order  of  animals,  when  the  access  of  air  is  by 
any  accident  impeded.  Now,  I  have  shown  elsewhere  that  this  peculiar 
sensibility  is  entirely  annihilated,  if  the  pneumogastric  nerve  be  divided  ; 
and  it  is,  therefore,  very  evident  that  on  this  nerve,  as  a  nerve  of  sensa- 
tion, the  high  degree  of  sensibility  peculiar  to  the  respiratory  organs  in 
the  higher  animals  depends.  The  deficiency  in  these  animals  of  that 
perfectly  developed  system  of  respiratory  muscles  found  in  most  of  the 
Vertebrata,  viewed  in  connection  with  the  diminutive  size  of  these 
respiratory  ganglia,  supports  the  opinion  advanced  elsewhere,  that  from 
these  bodies  issue  the  orders  for  the  respiratory  muscles  to  act. 

It  is  worthy  of  remark,  in  confirmation  of  the  views  regarding  the 
office  of  the  cineritious  neurine,  which  I  have  laid  before  the  reader 
elsewhere,  that  the  spinal  cord  of  the  turtle  is  immensely  enlarged  op- 
posite to  the  anterior  and  posterior  extremities,  the  muscles  of  which 
are  supplied  by  it,  whilst  between  these  points  it  is  contracted  to  a  mere 


Brain  of  the  turtle  seen  from 
above,  lateral  ventricle  opened. 
a.  Olfactory  nerre.  A.  Olfactory 
ganglion.  B.  Hemispherical  gan- 
glion. C&D.  Optic  ganglion.  E. 
Cerebellum.  F.  Auditory 
on.  H.  Spinal  cord.  K. 
mus  nervi  optici.  M.  Corpus 
striatum.  R.  Pineal  gland. 


AVES. 


95 


thread  ;  the  intercostal  system  of  muscles  being  entirely  deficient,  and 
instead  of  an  extensive  surface  of  skin  requiring  a  supply  of  nerves  of 
sensation,  as  in  man  and  the  Mammalia  generally,  there  is  a  hard,  in- 
sensible carapace. 

In  all  the  Reptilia  the  hemispheres  are  much  alike  in  their  smallness 
and  simplicity.  They  vary  a  little  in  shape. — In  the  crocodiles  they  are 
wide  posteriorly  and  narrow  in  front — something  of  a  heart  shape.  In 
serpents  they  are  wider  from  side  to  side.  In  all  the  saurians,  crocodiles, 
lizards,  &c.,  and  in  the  serpents,  the  cerebellum  is  very  small  and  very 
simple. 

Birds. —The  brain  and  spinal  cord  in  birds  are  developed  after  one 
uniform  type,  notwithstanding  the  amazing  diversity  of  external  form, 
habits  and  instincts  of  the  different  species  of  these  creatures. 

The  evident  advancement  in  intellectual  powers,  which  this  interesting 
tribe  of  the  animal  kingdom  exhibits  to  us,  is  found  to  correspond  with 
a  greater  development  of  the  hemispheres  of  the  brain.  The  proportion 
of  these  to  the  size  of  the  body,  to  the  other  cerebral  ganglia,  and, 
lastly,  to  the  spinal  cord,  is  far  superior  to  anything  we  have  met  with 
in  the  preceding  classes.  The  different  ganglia,  composing  the  encephalic 
mass,  are  not  placed  one  after  another,  as  in  the  skull  of  fishes  and  rep- 
tiles, but,  on  the  contrary,  are  rather  placed  under  one  another,  and  the 
hemispheres  or  cerebral  lobes  are  so  much  increased  in  size  that  they 
cover  all  the  different  ganglia  of  the  nerves  of  sensation;  so  that  on 
viewing  the  cerebral  mass  of  birds  from  above,  we  observe  only  two 
divisions — the  hemispheres  or  cerebrum,  and  the  cerebellum  ;  in  some 
instances  the  cerebrum  is  so  large  as  even  partly  to  overlap  the  cerebel- 
lum (fig.  37). 


Fig.  37. 


Fig.  38. 


Fig.  37.— Side  view  of  the  brain  of  the  bird,  showing  its  position  in  the  skull.  A.  Olfactory  ganglion. 
B.  Hemispherical  ganglion,  c.  Optic  ganglion.  E.  Cerebellum.  H.  Spinal  cord. 

Fig.  38. — Upper  surface  of  the  brain  of  the  woodpecker  (Leuret),  showing  the  first  commencement  of 
the  convolutions.  B.  Hemispherical  ganglion.  E.  Cerebellum.  H.  Spinal  cord. 

The  cerebral  lobes  in  most  birds  still  present  a  smooth  surface,  but  in 
some  birds  there  is  a  slight  furrow,  which  is  the  first  trace  we  meet  with 
of  that  folded  or  convoluted  appearance  which  is  so  characteristic  of  the 
brain  of  the  highest  order  of  animals.  The  brain  of  the  common  fowl, 
pigeon,  magpie,  blackbird,  loriat  and  crow,  is  perfectly  smooth  (see  fig. 
37);  but  that  of  the  buzzard  and  cuckoo  is  slightly  furrowed.  In  the 
duck  and  woodpecker  this  is  distinct  (fig.  38);  and  "  in  the  parroquet  it 
is  more  distinct  (says  Leuret)  than  in  any  bird  I  have  examined."* 

*  Leuret,  p.  277. 


96  COMPARATIVE    ANATOMY. 

The  cerebral  hemispheres  are  not  hollow,  as  in  fish  and  reptiles.  And 
let  it  be  remembered,  that  this  convoluted  arrangement  is  adopted 
simply  for  the  purpose  of  obtaining  a  larger  surface  of  cineritious  neurine 
in  a  smaller  space.  The  amount  of  surface  presented  by  a  convoluted 
brain,  if  extended  evenly,  would  cover  a  very  large  space,  and  take  up 
a  great  deal  of  room  ;  it  would  consequently  require  a  skull  of  corre- 
sponding dimensions  to  contain  it,  with  proportionally  large  muscles  to 
move  the  head.  Folded  backwards  and  forwards,  however,  in  the 
beautiful  manner  in  which  we  find  the  brain  arranged  in  man  and  the 
Mammalia  generally,  it  takes  up  but  little  room,  and  is  packed  into  a 
comparatively  small  box,  which  does  not  then  interfere  with  the  active 
powers  of  locomotion,  so  important  to  all  the  higher  animals  in  main- 
taining their  relations  with  the  external  world. 

The  cerebellum  in  birds  is  peculiarly  large — a  fact  which  tends  to 
confirm  the  views  of  many  intelligent  physiologists  of  the  present  day, 
that  it  presides  over  and  combines  the  action  of  separate  muscles  so  as 
to  produce  an  harmonious  result;  for  the  perfection  which  the  organs  of 
locomotion  attain  in  this  class  very  far  surpasses  all  that  we  have  yet  ob- 
served among  fishes  and  reptiles,  and  equals  at  least  the  degree  of  develop- 
ment exhibited  by  the  same  organs  in  any  other  species  or  class  of  living 
beings ;  the  cerebellum  is  divided  by  transverse  furrows  into  laminaB 
varying  in  number  from  10  to  20.  Leuret  names  12  in  the  partridge, 
15  in  the  duck,  16  in  the  parroquet,  20  in  the  male  magpie. 

Nevertheless  the  cerebellum  of  the  Bird  differs  from  the  same  organ 
in  the  Mammalia  in  one  important  particular ;  the  lateral  lobes  of  the 
cerebellum  are  almost  wholly  deficient  in  birds ;  in  man  they  are  so 
much  developed  that  the- central  portion,  consisting  of  the  superior  and 
inferior  vermiform  processes,  has  even  been  described  by  Reil  as  con- 
stituting a  mere  commissure.  The  cerebellum  of  the  Bird  consists,  in 
many  species,  of  little  more  than  the  middle  lobe,  which,  corresponding 
to  the  vermiform  processes  of  the  Mammalia,  proves  that  these  processes, 
instead  of  constituting  a  commissure,  form  the  fundamental,  and  conse- 
quently, we  may  suppose,  the  most  essential  portion  of  a  cerebellum. 
Serres*  remarks,  that  this  analogy,  which  was  first  observed  by  Haller, 
was  rejected  by  Malacarne,  and  neglected  by  most  subsequent  anatomists. 
The  lateral  hemispheres,  observes  the  same  author,  in  some  birds  are  so 
small  as  scarcely  to  be  visible ;  for  instance,  in  the  common  fowl,  the 
duck,  the  goose,  the  wren,  canary-bird,  and  sparrow:  but  they  are  very- 
distinct  in  partridges,  pigeons,  swallows,  birds  of  prey,  the  ostrich,  the 
cassowary  and  the  storks.  In  general,  in  birds  which  elevate  and  sustain 
themselves  a  long  time  in  the  air,  as  the  stork,  and  those  whose  wings 
or  feet  have  great  power,  as  the  emu,  cassowary,  and  parrots,  these 
hemispheres  appear  most  developed. 

The  olfactory  ganglia  are  small  in  birds,  and,  as  in  some  fishes,  are 
placed  close  to  the  cerebral  hemispheres,  so  that  the  commissures,  or 
peduncles  as  they  are  sometimes  called,  are  peculiarly  short,  presenting 
little  more  than  a  white  line,  which  runs  to  the  outer  side  of  the  hemi- 
spheres. 

*  A/iatomie  Compare  du  Cerveau,  vol.  ii.  p.  372. 


MAMMALIA. 


97 


The  optic  tubercles,  on  the  contrary,  are  very  large,  as  are  also  the 
nerves  which  arise  from  them. 

The  medulla  oblongata  is  more  than  -  Fis-  39- 

double  the  size  of  the  spinal  cord,  both 
in  width  and  depth ;  the  corpora  pyra- 
midalia,  the  olivary  bodies  and  pons 
Varolii  are  absent. 

The  hemispheres  of  the  brain  are 
connected  together  by  a  small  trans- 
verse commissure,  consisting  of  cineri- 
tious  matter  on  the  exterior,  of  filaments 
of  medullary  matter,  of  the  size  of  a 
thread,  in  the  interior;  the  analogue  of 
the  anterior  transverse  commissure  in 
man,  (see  fig.  39,  p,)  which  represents 
the  two  divided  ends  of  it.  It  has 
been  cut  in  separating  the  hemispheres. 
On  the  internal  surface  of  the  hemi- 
spheres (those  two  surfaces  which  are 
opposed  to  each  other,  and  in  the  hu- 
man brain  are  separated  by  the  falx 
major),  we  observe  some  diverging 
fibres  of  medullary  neurine,  which  pre- 
sent themselves  as  a  sort  of  footstalk  at 
the  under  part  of  the  hemispheres,  but 
really  commence  by  two  portions,  the 
one  from  the  outer  edge  of  the  tractus 
opticus,  the  other  from  the  inner.  That 
which  takes  its  course  to  the  outer 
side  is  connected  with  the  tractus  opti- 
cus, while  the  internal  appears  to  ter- 
minate in  the  tuber  cinereum.  This  structure  appears  to  me  analogous 
to  the  fornix  in  man. — (See  letter  N,  fig.  39.) 

In  the  brain  of  the  Bird  we  again  distinctly  observe  those*  collections 
of  cineritious  neurine  through  which  the  fibres  of  the  anterior  and  poste- 
rior columns  of  the  spinal  cord  proceed  in  their  passage  towards  their 
termination  in  the  hemisphere.  These  nodules  or  tubercles,  which  in 
the  human  subject  are  called  the  corpora  striata  and  thalami  nervorum 
opticorum  (fig.  39),  may  be  seen  in  the  Bird  by  separating  the  hemi- 
spheres and  breaking  down  the  commissure  which  connects  them.  They 
will  then  be  observed  partly  covered  by  the  optic  tubercles.  In  birds 
the  corpora  striata  are  very  large,  the  thalami  small.  As  they  are  more 
perfectly  developed  in  all  the  genera  of  the  succeeding  class,  I  shall  not 
at  present  dwell  longer  upon  the  character  they  exhibit. 

Brain  and  Spinal  Cord  in  the  Mammalia. — The  division  of  this  class 
into  two  sub-classes,  the  Placentalia  and  Implacentalia,  by  Professor 
Owen,  and  the  philosophical  researches  of  this  admirable  anatomist,  into 
the  organization  of  the  Implacentalia,  necessitate  our  considering  them 
separately.  It  is  found  that  the  brain  of  the  lowest  mammal  is  but  little 
in  advance  of  the  Bird ;  and  that  assertion  of  Cuvier,  that  the  pons 
7 


The  brain  of  the  goose  laid  open.  (From 
Spur/helm.)  On  the  right  hand  side  may  be 
seen  the  internal  surface  of  the  hemisphere 
without  any  section.  The  white  fibres  on  the 
surface  belong  to  the  fornix  or  longitudinal 
commissure.  On  the  left  side,  a  section  of 
the  hemisphere  has  been  made,  below  that 
called  the  antrum  ovale  in  the  human  brain; 
it  lays  open  the  lateral  ventricle,  exposing  the 
corpus  striatum  (M)  and  the  thalamus  (k). 
The  small  transverse  commissure,  analogous 
to  the  anterior  commissure  in  man,  is  divided, 
(p).  There  is  no  corpus  callosum.  a.  Olfac- 
tory nerve,  b.  Optic  nerve.  B.  Hemispheri- 
cal ganglion,  c.  Optic  ganglion.  E.  Cerebel- 
lum. F.  Auditory  ganglion.  N.  Longitudinal 
commissure,  or  fornix.  P  P.  Great  transverse 
commissure. 


98  COMPARATIVE    ANATOMY. 

Varolii  and  corpus  callosum  are  peculiar  to  the  Mammalia,  is  not  appli- 
cable to  the  Mammalia  as  a  whole,  but  only  to  the  Placentalia.  (The 
Implacentalia  are  divided  into  Monotremata  and  Marsupiata.) 

The  Monotremata  derive  their  name  from  their  having  a  common 
opening  for  faecal  evacuation  and  the  generative  function,  like  the  birds ; 
the  ornithorhynchus,  or  duck-billed  platypus,  is  our  most  familiar  exam- 
ple. The  brain  of  this  animal  is  extremely  simple  ;  the  hemispheres  are 
small  and  smooth  like  the  bird,  the  whole  brain  only  bearing  a  propor- 
tion to  the  body  of  1  to  130. 

The  optic  tubercles  are  covered  more  completely  than  in  the  Bird, 
and  they  are  partially  divided,  shadowing  forth  the  complete  division 
into  four  bodies,  which  we  meet  with  in  the  placental Mammalia.  "The 
posterior  bigeminal  body,"  says  Owen,  (Art.  Monotremata,  Cyc.  Anat., 
Tol.  iii.  p.  383,)  "  is  much  smaller  than  the  anterior,  and  the  transverse 
depression  which  divides  them  is  very  feebly  marked ;  the  longitudinal 
groove  is  equally  feeble  on  the  nates,  and  is  altogether  absent  in  the 
testes,  which  thus  form  a  single  tubercle." 

The  commissural  apparatus  presents  the  same  peculiarity  and  defi- 
ciency as  in  the  Marsupiata  to  be  described  presently.  Thus  we  do  not 
find  any  sudden  transition  from  one  form  of  brain  to  another  ;  there  is  no 
great  chasm  between  the  brain  in  birds  and  that  of  the  Mammalia. 

Mr.  Owen,  in  his  interesting  paper  on  the  brain  of  Marsupiate  Ani- 
mals, published  in  the  Philosophical  Transactions,  Part  I.,  1837,  has 
shown  that  the  link  between  birds  and  Mammalia  is  more  perfect  than 
was  previously  believed. 

The  commissural  apparatus  in  birds  we  have  already  seen  is  extremely 
simple,  consisting  of  a  mere  cord-like  transverse  commissure  and  a  rudi- 
mentary fornix. — In  the  rodent,  or  gnawing  Mammalia,  as  the  rat, 
mouse,  squirrel,  rabbit,  beaver,  the  hemispheres  are  almost  as  smooth  as 
in  birds,  but  the  commissural  apparatus  is  nearly  as  perfect  as  in  man, 
as  the  student  will  perceive  when  he  reads  the  description  of  the  brain 
of  the  rabbit,  given  a  little  further  on. 

In  the  marsupiate  animals,  however,  it  is  very  different,  for  the  great 
transverse 'commissure,  or  corpus  callosum,  is  scarcely  larger  than  the 
anterior  commissure  in  the  Bird,  and  the  fornix  is  quite  rudimentary.* 

The  brain  bears  a  smaller  proportion  to  the  body  in  the  marsupials 
than  in  any  other  order  of  mammals  :  thus  in  the  Ursine  Dasyure  it  is  as 
1  to  820,  in  the  Wombat  as  1  to  614,  in  the  Kangaroo  as  1  to  800. 
Mr.  Owen  thus  states  how  he  was  led  to  the  discovery  of  this  important 
distinction  between  the  structure  of  the  brain  in  the  placental  and  mar- 
supial Mammalia. 

"  From  the  fact  that  the  cerebral  organ  is  that  which  exhibits  the 
most  marked  degradation  of  structure  in  the  class  of  warm-blooded  ver- 
tebrate animals,  which  are  characterized  by  an  oviparous  generation,  I 
was  induced  to  suspect,  after  having  ascertained  how  closely  the  Marsu- 
piata approached  birds  in  their  mode  of  generation,  that  the  brain  might 
present  in  them  some  corresponding  inferiority  of  structure,  as  compared 
with  the  placental  Mammalia. 

*  Encycl.  of  Anatomy,  p:  89. 


MARSUPIATA.  99 

"An  attentive  study  of  the  manners  of  different  marsupials  in  confine- 
ment, and  an  inspection  of  the  exterior  forms  of  the  brain  in  some  of  the 
species,  induced  me  to  allude,  in  my  paper  on  the  Kangaroo,  to  an  infe- 
riority of  intelligence,  and  a  low  development  of  the  cerebral  organ,  as 
being  the  circumstances  in  the  habits  and  structure  of  these  singular  ani- 
mals which  were  most  constantly  associated  with  the  peculiarities  of 
their  generative  economy.  I  have  since  the  most  satisfactory  confirma- 
tion of  this  coincidence,  from  repeated  dissections  of  the  brains  of  mar- 
supials belonging  to  different  genera,  and  although  unable  to* explain 
how  a  brief  uterine  existence,  and  the  absence  of  a  placental  connection 
between  the  mother  and  foetus,  can  operate  (if  it  be  really  effective)  in 
arresting  the  development  of  the  brain,  yet  it  is  a  coincidence  which  has 
been  so  little  suspected,  and  is  so  interesting  in  various  points  of  view, 
that  I  believe  the  evidence  of  it  will  be  acceptable  both  to  the  physiolo- 
gist and  the  naturalist." 

Fig.  40.  Fig.  41. 


Fig.  40.— Upper  surface  of  the  brain  of  the  beaver,  reduced  one-half.  (Owen.)  A.  Cerebral  hemi- 
spheres, a.  Olfactory  ganglion,  c.  Cerebellum. 

Fig.  41.— Upper  surface  of  the  brain  of  the  wombat,  reduced  one-half.  (Owen.)  A.  Cerebral  hemi- 
spheres, a.  Olfactory  ganglion.  B.  Optic  ganglion,  c.  Cerebellum. 

Mr.  Owen  compared,  step  by  step,  the  brain  of  the  Marsupial  Wombat 
and  the  Rodent  Beaver ;  and  though  these  creatures  are  so  alike  in  out- 
ward form  and  habits  of  life,  that  they  have  been  classed  in  the  same 
Order  by  some  naturalists,  he  discovered  this  most  important  difference 
of  organization — on  the  outward  surface,  the  brain  of  the  wombat  ap- 
pears more  highly  organized  than  that  of  the  beaver,  a.s  it  presents  some 
appearance  of  convolutions,  while  the  brain  of  the  beaver  is  quite  smooth 
(see  figs.  40  and  41).  But  in  the  beaver  the  hemispheres  of  the  brain 
are  longer,  and  extend  backwards  further,  so  as  to  cover  the  optic  tuber- 
cles, which  they  do  not  completely  in  the  wombat. 

On  separating  the  hemispheres  of  the  brain  in  the  beaver,  we  bring 
into  view  a  broad  and  distinctly  fibrous  commissure — the  great  trans- 
verse commissure  or  corpus  callosum.  This  may  be  traced  into  the 
.hemispheres  on  each  side,  as  in  the  human  brain  (see  fig.  42).  On 
separating  the  cerebral  hemispheres  of  the  wombat,  there  is  no  such 
commissure :  not  only  are  optic  tubercles  and  pineal  glands  uncovered 


100 


COMPARATIVE   ANATOMY. 


as  in  the  beaver,  but  the  optic  thalarai  also.  Instead  of  a  broad  corpus 
callosum,  we  perceive,  situated  deeply  at  the  bottom  of  the  hemispheric 
fissure,  a  small  commissural  medullary  band  (see  fig.  43,  n),  passing  in 
an  arched  form  over  the  anterior  extremity  of  the  thalami,  and  extending 
beneath  the  overlapping  interior  or  mesial  surfaces  of  the  hemispheres, 
which  thus  appear,  as  in  the  bird,  to  be  wholly  disunited.  This  band 
of  fibres  (n)  is  the  analogue  of  the  fornix.  "  As  the  great  commissure 
is  wanting,"  says  Mr.  Owen,  "  in  the  brain  of  the  Great  and  Bush  Kan- 
garoos, the  Vulpine  Phalanger,  the  Ursine  and  Mangles  Dasyures,  and 
the  Virginian  Opossum,  it  is  most  probably  characteristic  of  the  marsu- 
pial division  of  Mammalia." 


Fig.  42. 


Fig.  43. 


Fig.  42.— Brain  of  the  beaver,  with  the  substance  of  the  hemispheres  remeved  to  the  level  of  the  corpus 
callosum :  reduced  one-half.  (Owen.)  B.  Optic  ganglia,  c.  Cerebellum.  1.  Corpus  callosurn.  u.  Pineal 
gland. 

Fig.  43.  Brain  of  the  wombat,  with  the  substance  of  the  hemispheres  removed  to  the  level  of  the  fornix, 
except  on  the  right  side,  where  part  of  the  thin  internal  wall  of  the  lateral  ventricle  is  left;  reduced  one- 
half.  (Owen.)  B.  Optic  ganglia,  a.  Olfactory  ganglia,  m.  Fornix.  n.  Hippocampus  major,  o.  Ante- 
rior fibres  of  the  tsenia  hippocampi  connected  with  the  anterior  lobes  of  the  hemispheres,  p.  Plexus 
choroides.  q.  Septum  lucidum.  r.  Corpus  striatum.  1 1.  Optic  thalami.  u.  Pineal  gland. 

It  is  stated  in  the  last  edition  (1845)  of  Cuvier's  Lecons,  in  reference 
to  the  commissural  apparatus  in  the  Marsupiata,  that  at  the  same  time 
that  the  great  transverse  commissure  diminishes,  the  anterior  commis- 
sure increases  to  an  enormous  size;  it  is,  in  the  brain  of  the  kangaroo, 
four  times  larger  than  the  anterior  commissure  in  the  brain  of  the  ox, 
•while  the  size  of  the  brain  itself  is  four  times  smaller. 

Mr.  Owen  also  gives  drawings  of  two  species  of  herbivorous  and  two 
of  carnivorous  Marsupiata,  to  show  the  indications  of  superior  develop- 
ment which  distinguish  the  brain  of  the  herbivora,  in  the  greater  propor- 
tional development  of  the  cerebrum,  its  convoluted  surface,  and  the 
smaller  proportional  size  of  the  olfactory  tubercles.  In  all  species,  but 
especially  the  carnivorous  marsupials,  the  greater  relative  size  of  the 
vermiform  process  is  deserving  of  notice,  as  indicating  the  approach  to 
the  oviparous  type  of  cerebral  structure.  It  is  associated  with  a  corre- 
sponding diminution  of  the  pons  Varolii. 


RODENTIA.  101 

Mammalia  Placentalia. — The  lowest  animals  of  the  true  Mammalia 
are  the  Rodent,  or  gnawing  animals,  such  as  the  rat,  rabbit,  squirrel, 
&c.,  and  to  them  we  will  now  direct  our  attention. 

The  following  description  of  the  brain  of  the  rabbit  has  been  minutely 
given,  because  this  animal  is  always  easily  to  be  procured,  and  because 
I  am  sure  that  whoever  will  take  the  trouble  to  dissect  it,  before  attempt- 
ing that  of  the  human  brain,  will  find  his  path  much  facilitated  by  the 
knowledge  and  the  manual  dexterity  he  will  have  acquired. 

He  will  be  prepared,  too,  to  take  a  more  correct  view  of  the  human 
brain,  and  his  mind  will  be  divested  of  many  of  those  feelings  of  awe  and 
mystery,  which  have  unfortunately  been  hitherto  so  constantly  associated 
with  its  structure. 

When  the  upper  part  of  the  skull  of  the  rabbit  is  removed,  we  ob- 
serve that  the  cerebral  mass  consists  of  three  grand  divisions:  the  first 
and  smallest  of  these  comprises  the  olfactory  tubercles;  the  second,  the 
hemispheres;  the  third,  the  cerebellum;  the  other  ganglia  remain  entirely 
concealed.  The  hemispheres  are  slightly  marked  on  the  surface,  but 
not  a  tall  convoluted. — (See  fig.  44.)  On  separating  the  hemispheres, 
we  find  them  connecting  together  by  a  band  of  medullary  neurine,  called 
in  the  human  subject  the  great  transverse  commissure,  or  corpus  callosum. 

Fig.  44.  Fig.  45. 


Fi"[.  44. — Brain  of  the  rabbit,  upper  surface.  A.  Olfactory  ganglion.  B.  Hemispherical  ganglion.  E.  Ce- 
rebellum. H.  Spinal  cord. 

Fig.  45. — Brain  of  the  rabbit;  hemispheres  turned  back,  exposing  the  corpus;  striatum  and  optic 
thalamus  on  the  right ;  the  former  on  the  left  side  covered  by  the  fornix  or  longitudinal  commissure.  A. 
Olfactory  ganglion.  B.  Hemispherical  ganglion,  c.  Optic  ganglion.  D.  Testes,  or  posterior  optic  ga"n- 
glion.  E.  Cerebellum.  K.  Thalamus  nervi  optici.  R.  Pineal  gland,  m.  Corpus  striatura.  n.  Longitudinal 
commissure,  or  fornix. 

If  the  great  transverse  commissure  be  now  divided,  and  the  hemi- 
spheres separated  from  each  other,  several  parts  of  importance  beneath 
it  will  be  exposed  (see  fig.  45).  Commencing  from  the  posterior 
part,  we  observe  just  in  front  of  the  cerebellum  four  rounded  bodies, 
the  posterior  (D)  of  which  are  small,  not  being  more  than  a  fourth 
part  as  large  as  the  anterior  (c).  These  four  bodies  are  analogous 
to  the  single  pair  of  optic  tubercles  in  the  bird,  and  in  man  are  called 
the  tubercula  quadrigemina,  or  the  posterior  the  testes,  and  the  an- 


102  COMPARATIVE    ANATOMY. 

terior  the  nates.  Immediately  anterior  to  these  bodies  we  find  two 
other  rounded  projections,  the  anterior  of  which  is  the  larger.  The 
posterior  (K)  is  formed  by  a  body  which,  in  the  human  brain,  is  known 
by  the  name  of  the  thalamus  nervi  optici,  but  this  is  not  the  true  optic 
ganglion,  though  it  does  receive  some  fibres  from  the  optic  nerve. 
This  projection,  though  principally  formed  by  the  optic  thalamus,  is  not 
solely  formed  by  it;  for  covering  the  thalamus,  we  find  a  thin  layer  of 
medullary  neurine,  the  outer  edge  of  which  corresponds  to  that  of  the 
thalamus,  so  that  in  this  stage  of  the  dissection  the  thalamus  is  not  really 
exposed.  This  band  of  medullary  neurine,  inferior  longitudinal  com- 
missure, consists  of  two  sets  of  fibres ;  one  set  appears  to  correspond  to 
the  tenia  semicircularis  in  man,  lying  between  the  thalamus  and  corpus 
striatum;  the  other  comes  from  the  under  and  back  part  of  the  brain. 
It  rises  up  from  this  part,  covering  in  its  course  a  large  internal  convo- 
lution, the  hippocampal  lobe — hippocampus  major.  From  this  part,  we 
find  it  passing  forwards  and  inwards,  and  winding  over  the  surface  of 
the  thalamus,  and,  running  in  front  of  it,  dips  down  to"  the  under  part 
of  the  brain,  forming  the  anterior  pillars  of  the  fornix,  and  terminates 
partly  in  that  portion  of  the  spinal  cord  which  in  the  human  subject  is 
known  by  the  name  of  the  crus  cerebri,  and  partly  in  the  thalamus.  The 
beautiful  structure  just  described  forms  a  communication  between  the 
anterior  and  posterior  portions  of  the  hemisphere  of  the  same  side,  and 
runs  along  the  course  of  the  mesial  line.  In  the  brain  of  man  this  band 
has  hitherto  gone  by  the  name  of  fornix,  but  I  have  named  it  inferior 
longitudinal  commissure,  as  being  more  in  accordance  with  its  structure 
and  probable  function.  If  an  incision  extending  in  a  direction  forwards 
and  outwards,  be  made,  commencing  at  the  optic  ganglion,  completely 
through  this  commissure,  the  optic  thalamus  will  be  exposed. 

The  projection  which  is  immediately  anterior  to  the  thalamus  is  ana- 
logous to  the  corpus  striatum  of  the  human  brain,  a  part  that  has  received 
its  name  from  the  striated  appearance  it  presents  on  a  section  being 
made  of  its  substance ;  the  cineritious  neurine  being  deposited  in  stria3 
between  the  white  fibres  which  are  passing  from  the  hemispheres  to  the 
anterior  columns  of  the  spinal  cord.  The  corpus  striatum  and  thalamus 
are,  therefore,  deposits  of  neurine,  through  which  the  component  fibres 
of  the  anterior  and  posterior  columns  of  the  spinal  cord  pass  in  their 
course  from  and  to  the  hemispheres,  and  have  been  characterized,  I 
think  advisedly,  by  Spurzheim,  as  ganglia.  The  corpus  striatum  should 
be  entitled  the  anterior,  and  the  thalamus  the  posterior,  cerebral  ganglion 
of  the  cord.  Running  near  the  edge  of  the  thalami,  towards  the  nates, 
are  two  white  lines,  which,  turning  off  at  a  right  angle  to  cross  the 
mesial  line,  meet  with  a  very  small  cineritious  body,  about  the  size  of  a 
pin's  head.  This  little  body  is  the  pineal  gland  (R)  ;  the  whole  structure 
forms  a  commissure  between  the  two  opposite  thalami,  and  maybe  called 
the  pineal  commissure.  Situated  immediately  beneath  the  pineal  gland, 
and  between  the  thalami,  is  a  transverse  band,  which  in  the  rabbit  is 
not  much  thicker  than  a  thread,  called  the  posterior  commissure,  immedi- 
ately in  front  of  which  is  a  middle  band  of  cineritious  neurine,  and  still 
further  forward  is  another;  these  are  respectively  called  the  anterior  and 


RODENTIA. 


103 


Fig.  46. 


middle  commissures  of  the  brain,  in  distinction  to  the  posterior  commis- 
sure. 

The  hemispheres  having  been  completely  turned  back  in  the  perform- 
ance of  this  dissection,  the  student  cannot  fail  to  observe  that  they  form 
a  sort  of  cap  to  the  anterior  and  posterior  cerebral  ganglia  of  the  cord, 
covering  them  something  in  the  same  way  that  the  head  of  a  mushroom 
does  the  footstalk  ;  the  space  left  is  the  lateral  ventricle.  The  admira- 
ble contrivance  by  which  the  immense  quantity 
of  neurine  composing  the  large  cerebral  ganglia 
in  these  animals  is  lodged  in  such  a  circumscribed 
space  as  the  cranial  cavity,  must  be  interesting 
to  the  reflecting  student. 

If  the  brain  be  now  removed  from  the  skull,  re- 
versed so  as  to  expose  the  under  surface  (see  fig. 
46),  and  the  eye  carried  along  the  spinal  cord,  it 
will  be  observed  that  the  cord  becomes  of  nearly 
double  the  thickness  it  possessed  within  the  verte- 
bral canal.  This  thickened  portion  of  the  cord 
is  called  the  medulla  oblongata,  and  contains  with- 
in its  substance  the  olivary  bodies,  the  pneumo- 
gastric  ganglia,  and  the  posterior  pyramidal  or 
auditory  ganglia.  Crossing  the  medulla  oblongata 
transversely  is  a  band  of  medullary  neurine,  which, 
running  from  one  side  of  the  cerebellum  to  the  op- 
posite, forms  the  Commissure  Of  that  part,  and  is  Brain  of  the  rabbit,  under 

usually  known  by  the  name  of  the  pons  Varolii  w^jJJS^  The^rTfe- 
w  tuber  annulare  (p  v).  The  spinal  cord  beyond  ±voffiont  tL^Te 
this  commissure  splits  into  two  portions,  which,  hippocampus,  to  which  phre- 

.  .  !•  i          •       i  nologists  have  appropriated 

running  to    the  two  corresponding   hemispheres,    the   organ  of  aii 


are   called  the  crura,  or  legs  of  the  brain  (p  c).     SVnon  S&  nne™.  * 


Between  them  is  the  collection  of  cineritious  neu- 
rine called   the  tuber  cinereum,  and  immediately 


the  eyes,  or  motores  oculo- 
rum.    e  m.  Corpus  mammil- 
lare.  p  c.  Crus  cerebri.  p  v. 
.,    ,,  .  „     ,  .  -        Pons    varolii.      b  t.    Corpus 

anterior  to  it  the  commissure  or  the   optic  nerves,    trapezoidum.  p  a.  Anterior 

The  hemispheres  appear  divided  into  two  lobes  on    gSSStJSS'   *  ':  C°T' 

each  side,  and  the  fissure  of  separation  is  called 

ihefissura  Sylvii.     The  commissure  between  the  olfactory  ganglia  and. 

the  hemispheres  is  of  considerable  width,  consisting  of  cineritious  and 

medullary  -neurine,  but  it  is 

short  when  compared  with  Fig.  47. 

that  of  the  carp  and  whiting. 

The  under  part  of  the 
hippocampal  lobes  are  now 
distinctly  seen,  and  the  great 
size  should  be  observed. 

In  the  porcupine  and 
agouti  the  auditory  ganglia 
are  of  great  size.  In  the 
squirrel  the  hemispheres  are 

Smooth    (fig.   47),    the    Olfac- 

tory  ganglia   large,  as  also 


Side  view  of  the  head  and  brain  of  a  squirrel.    A.  Olfactory 

Hemi8Pherical  &a^lion-  E-  Cerebellura-  "•' 


COMPARATIVE    ANATOMY. 


Fig.  48. 


thai.  Thaiamus  nervi  optki. 

es.  Corpus  striatum. 


the  cerebellum,  so  that,  on  a  lateral  view,  the  whole  encephalon  bears 

much  resemblance  to  that  of  the  bird  :  when  this  brain  is  dissected  (fig. 

48),  the  small  size  of  the  hemispherical  ganglia,  in  proportion  to  the 

other  cerebral  ganglia,  is  well  seen. 

Next  to  the  Rodentia,  in  the  class  Mam- 
malia,  is  the  order  Edentata,  or  toothless 
animals.  This  order  includes  the  sloths, 
and  the  extinct  genera  of  gigantic  sloths, 
such  as  the  megatherium.  The  brain  is 
simple,  and  affords  no  peculiarities  of  phy- 
siological interest. 

We  next  come  to  the  °rder  Ruminantia, 
of  which  the  Sheep  is  a  familiar  illustration. 
The  facility  of  procuring  the  brain  of  the 
sheep,  and  the  slight  cost  at  which  mul- 
tiplied dissections  of  it  may  be  made,  in- 
duce me  to  bring  it  under  the  notice  of  the 
student,  as  affording  another  characteristic 

Brain  of  the  squirrel:  hemispheres    link  in  the  chain  of  cerebral  complication, 

from  the  lower  to  the  higher  tribes  of  crea- 
tion>  9nd  its  termination  in  man.  Investi- 
options  of  this  kind,  indeed,  ought  to  be 

i      i  i  •  i 

pursued  through  as  extensive  and  varied  a 
series  of  animals  as  can  be  procured  ;  each  offers  some  peculiarity  well 
worthy  of  attention,  and  all  confirm  the  important  truth  in  the  science  of 
zoological  anatomy,  without  which  human  anatomy  is  but  a  limited  and 
unsatisfactory  pursuit,  that  every  one  of  the  organs  through  the  whole  of 
the  animal  kingdom  is  constructed  on  one  uniform  and  simple  plan.  The 
brain  of  man,  which  had  so  long  been,  and  even  now  remains,  an  ob- 
stacle in  the  path  of  the  teacher  and  student  who  restrict  themselves  to 
the  limits  of  human  dissection,  may  be  shown  to  have  been  formed  with 
the  same  attention  to  the  beautiful  simplicity  which  distinguishes  all  the 
varied  forms  of  organized  existence.  The  minute  description  which  has 
been  given  of  the  anatomy  of  the  brain  of  the  rabbit,  makes  it  unneces- 
sary to  dwell  with  the  same  attention  to  detail  on  each  point  in  that  of 
the  sheep  ;  so  that  I  shall  merely  mention  those  particulars  in  which  they 
differ,  and  thus  point  out  some  others  in  which  the  brain  of  the  sheep 
approaches  more  in  its  structure  to  that  of  man. 

The  upper  surface  of  the  cerebral  mass  of  the  sheep  presents,  on  each 
side,  three  divisions  —  the  olfactory  ganglion,  the  hemispherical  ganglion, 
and  the  cerebellum  (see  fig.  49).  The  olfactory  ganglia  may  be  seen  in 
front  of  the  hemispheres,  as  in  the  rabbit;  'for  although  the  hemispheres 
have  increased  so  much  in  size,  still  they  do  not  yet  completely  cover  or 
conceal  them  —  the  olfactory  ganglia  being  also  very  large.  The  hemi- 
spheres are  not  merely  of  larger  relative  dimensions,  but  their  shape  is 
altered  :  they  have  lost  the  pyriform  character  they  presented  in  the 
rodent  animal,  and  have  assumed  more  of  the  oval  form  which  they 
possess  in  the  human  being.  Their  surface,  instead  of  being  smooth, 
is  much  convoluted,  looking  exactly  as  if  it  were  formed  by  the  folding 


RUMINANTIA. 


105 


up  a  soft  but  tenacious  substance.   The  cerebellum  is  not  much  changed 
in  appearance  ;  it  is  oaly  samewhat  larger  in  proportion  to  the  cerebrum. 


Fig.  49. 


Brain  of  the  sheep,  natural  size.  (Leuret.) 
Cerebellum. 


A.  Olfactory  ganglion.    B.  Hemispherical  ganglion.    E, 


The  great  transverse  commissure  has  increased  in  accordance  with  the 
greater  development  of  the  hemispheres ;  and  when  we  divide  it  in  the 
middle,  and  turn  either  half  back,  in  order  to  expose  the  optic  tubercles, 
the  thalami  and  corpora  striata,  we  find  the  latter  appearing  as  if  they 
were  placed  within  a  circumscribed  cavity,  so  much  have  the  hemispheres 
increased  in  size  in  every  direction.  The  space  which  is  left  between 
the  corpora  striata  and  thalami,  and  the  under  surface  of  the  hemispheres, 
has  been  described  in  the  human  brain,  under  the  name  of  lateral  ven- 
tricle, as  if  it  were  a  cavity  or  chamber  scooped  out  of  the  substance  of 
the  brain.  But  it  must  be  evident  to  every  one  who  has  followed  the 
gradual  development  of  the  hemispheres  from  before  backwards,  that 
this  space  is  merely  a  fissure  analogous  to  those  fissures  which  are  met 
with  on  the  surface  of  the  brain  between  opposing  convolutions,  the  fossa 
digitata.  We  find,  in  fact,  that  the  spaces  denominated  lateral  ventri- 
cles are  the  necessary  effect  of  the  drawing  back,  if  I  may  so  express  it. 


106 


COMPARATIVE   ANATOMY. 


of  these  extensive  surfaces  of  neurine  covering  the  crura  cerebri  or 
anterior  productions  of  the  medulla  oblongata.  By  the  addition  of  the 
anterior  and  posterior  cerebral  ganglia  of  the  cord  (the  corpus  striatum 
and  thalamus),  the  structure  comes  to  bear  a  considerable  resemblance 
to  a  head  of  cauliflower  included  within  its  capsule  of  leaves,  or,  as  I 
have  said  elsewhere,  to  the  nodulated  head  of  a  walking-stick,  over  and 
around  which  a  piece  of  cloth  has  been  tied,  and  then  reflected  forwards 
upon  itself. 

The  edge  of  the  fornix  or  longitudinal  commissure  may  be  seen  lying 
in  the  groove  between  the  anterior  and  posterior  cerebral  ganglia ;  the 
posterior  ganglion,  or  thalamus,  being,  however,  so  completely  covered 
that  it  cannot  be  seen  until  the  commissure  is  completely  divided  and 
reflected  outwards.  If  the  hemispheres  be  now  turned  forward,  the 
cerebral  ganglia  on  both  sides  will  be  exposed,  with  the  pineal  commis- 
sure, and  tubercula  quadrigemina.  Crossing  the  fissure  between  the 
posterior  cerebral  ganglia,  (absurdly  called  the  third  ventricle,)  the  com- 
missura  mollis,  or  middle  commissure,  will  also  be  brought  into  view. 

Fig.  50. 


Brain  of  the  sheep  removed  from  the   skull,  and  lying  oh  its  upper  surface,  siz< 

rnglipn.     B.  Hemispherical  ganglion.    E.  Cerebellum,    i.  Tuber  cinereum     a. 
Optic  nerve,    c.  Third  nerve     d.  Fourth  nerve,     e.  Fifth  nerve.    /.  Sixth  ner 


size  of  life.    A.  Olfactory 
a.  Olfactory  commissure. 

!>.  Optic  nerve,    c.  Third  nerve     d.  Fourth  nerve,     e.  Fifth  nerve.   /.  Sixth  nerve,    g.  Seventh,  facial  . 

h.  Eighth,  auditory,    i.  Ninth,  glosso-pharyngeal.    j.  Tenth,  par  vagum.    k.  Eleventh,  lingual,    x.  Pons 

Varolii. 

. 

On  the  base  or  under  surface  of  the  brain  we  observe  that  the  olfac- 
tory ganglia  or  tubercles  (see  fig  50)  are  very  highly  developed ;  they 
are,  in  fact,  nearly  three  times  as  large  as  those  of  the  human  subject,  a 
size  which  appears  to  correspond  with  the  complicated  structure  of  the 
nose  in  this  animal,  and  to  be  in  proportion  to  the  acuteness  of  their 
sense  of  smell.  The  olfactory  commissures  are  short  and  thick,  scarcely 
a  line's  breadth  being  left  between  the  tubercle  and  the  point  where 
they  are  united  to  the  under  surface  of  the  hemispheres.  These  com- 
missures extend  backwards  to  the  hippocampal  lobes,  which  is  some  way 
further  than  the  point  where  they  are  first  attached  to  the  surface  of  the 
cerebrum.  We  need  go  no  further  to  prove  the  absurdity  of  still  denomi- 
nating analogous  parts  in  the  human  being,  nerves.  The  olfactory  ganglia 
themselves  are  composed  of  medullary  and  cineritious  neurine. 


RUMINANTIA. 


Fig.  51. 


The  pons  Varolii  (#),  or  tuber  annulare  of  Willis,  is  small  in  the  sheep 
compared  with  the  same  part  in  man  :  here  it  is  not  more  than  three 
lines  in  breadth.  The  corpora  mammillaria  are  united  so  as  to  appear 
like  a  single  body.  The  tuber  cinereum  is  not  particularly  distinct ; 
through  its  centre  we  find  a  sort  of  funnel-shaped  tube  passing,  called 
the  infundibulum,  which  joins  a  rounded 
structure  situated  on  the  sphenoid  bone, 
called  the  pituitary  gland.  The  character 
or  analogy  of  the  last-mentioned  parts  is 
extremely  obscure,  and  there  is  a  mystery 
here  which  has  not  yet  been  unraveled. 
The  medulla  oblongata,  like  that  of  the 
rabbit,  is  very  thick  in  comparison  with  the 
spinal  cord. 

The  anatomy  of  the  medulla  oblongata 
presents  many  points  of  interest.  But  in 
order  to  understand  them  it  is  necessary  to 
anticipate  a  little.  If  the  reader  will  refer 
to  my  description  of  the  part  in  man,  he 
will  find  that  the  surface,  viewed  anteriorly 
and  externally,  presents  those  projections 
named,  from  their  shape,  the  corpus  pyra- 
midale,  the  corpus  olivare,  and  corpus 
restiforrn.  The  corpus  pyramidale  is  part 
of  the  anterior  column  of  the  cord,  which 
must  not  be  considered  an  isolated  body  or 
ganglion,  but  merely  an  appearance  caused 
by  the  decussation  which  the  fibres  of  the 

column  take  at  this  part.  They  do  not  descend  perpendicularly  on  the 
same  side,  but  they  cross  over  to  the  opposite  side,  decussating  with 
their  fellows;  the  corpora  pyrarnidalia  in  the  sheep  are  small.  The 
corpus  olivare  is  a  true  ganglion — a  collection  of  cineritious  neurine. 
The  corpus  restiforme  contains  a  ganglion  which  is  connected  with  the 
pneumogastric  nerve  ;  it  is  the  homologue  of  the  branchiogastric  gan- 
glion in  fish.  It  may  be  called  the  pneurnogastric  or  restiform  ganglion. 

If  the  posterior  surface  of  the  medulla  is  examined,  a  fourth  projection 
may  be  seen  projecting  on  each  side  of  the  mesial  line,  of  a  pyramidal 
form — the  posterior  pyramidal  bodies,  or  auditory  ganglia  (F  F). 

Thus  it  will  be  found  that  the  medulla  oblongata  contains  on  each 
side  three  ganglia,  while  each  vertebral  section  of  the  spinal  cord  only 
contains  two,  the  anterior  and  posterior  peaks  of  gray  matter. 

The  distinction  between  these  last-named  ganglia  is  better  seen  in 
some  of  the  lower  Mammalia,  after  making  a  transverse  section,  than  in 
man.  I  believe  that  in  all  the  Mammalia,  except  the  monkey,  the  ele- 
phant, and  the  porpoise,  the  corpora  olivaria  do  not  project  on  the  sur- 
face, and  hence  the  assertion  by  some  anatomists,  that  they  are  wanting 
in  most  of  the  Mammalia. 

Longet  says,  p.  390,*  "  The  olivary  bodies  attain  their  highest  deve- 

*  Anatomie  et  Physiologic  du  systeme  Nerveux  de  Thomme  et  des  animaux  Vertebras, 


Medulla  oblongata  and  pons  Varolii 
of  the  sheep.  Nos.  1,  2,  and  3,  with  the 
lines,  mark  the  sections,  the  surfaces  of 
which  are  exhibited  in  the  next  figure 
(52).  The  lines  are  not  drawn  at  right 
angles  to  the  cord,  as  they  should  be 
/.  Sixth  nerve,  j.  Tenth,  par  vagum. 
k.  Eleventh,  lingual.  Y.  Corpus  trape 
zoidum. 


108 


COMPARATIVE   ANATOMY. 


lopment  in  the  human  species  ;  it  is  often  impossible  to  perceive  these 
eminences  in  other  Mammalia." 

"  Having  carefully  examined,"  says  Rolando,  "the  place  where  these 
eminences  ought  to  be,  I  can  assert  that  they  are  not  to  be  met  with  in 
the  ox,  pig,  sheep  or  goat." 

Carus  affirms  u  that  they  are  wholly  absent  in  most  Mammalia,  or  at 
least  that  they  do  not  present  the  arborescent  appearance  of  white  and 
gray  neurine  which  they  do  in  man." 

I  have  found  these  ganglia  in  the  sheep,  horse,  calf  and  cat,  and  I 
have  no  doubt  that  they  exist  in  all  Mammalia. 

"  Gall,"  says  Longet,  "  has  certainly  exaggerated  their  volume  in  the 
calf;  they  are  sufficiently  apparent  in  the  apes,  but  especially  in  por- 
poises and  in  the  dolphins." 

In  the  sheep  the  corpora  olivaria  do  not  project  on  the  surface.  They 
are  best  detected  by  a  transverse  section  ;  and  they  will  be  found,  not 
on  the  side  of  the  pyramidal  bodies,  but  behind  (see  fig.  52) ;  s  repre- 
sents the  appearance  they  exhibit.  It  is  taken  from  a  drawing  which  I 
made  with  Mr.  Grainger.  We  afterwards  examined  it  under  the  micro- 
scope, and  found  the  ganglionic  corpuscles  very  beautifully  distinct.  Its 
exact  longitudinal  extent  I  cannot  assert,  but  there 
was  no  appearance  of  it  in  a  section  made  just 
above  s,  No.  3  ;  fig.  52  exhibits  what  I  believe 
is  its  inferior  extremity.  In  the  human  subject 
they  are  much  larger,  though  the  neurine  is  folded 
into  a  small  space,  but  if  extended  it  would  oc- 
cupy nearly  one  inch  in  breadth.  The  auditory 
and  pneumogastric  ganglia  are  also  very  distinct 
(same  fig.,  F  arid  G).  Finally,  there  is  an  ap- 
pearance on  the  surface  of  the  medulla  to  which 
there  is  nothing  analogous  in  the  human  brain. 
This  is  produced  by  a  transverse  fibrous  band 
running  just  below,  and  parallel  to,  the  pons  Va- 
rolii,  from  the  restiform  bodies  to  the  edge  of  the 
anterior  columns  (see  fig.  51) :  Y  is  called  the 
corpus  trapezoidum.  It  is  met  with  in  all  Mam- 
malia, except  the  ourang-outang,  chimpanzee, 
and  man. 

The  cerebral  nerves  take  precisely  the  same 
origin  in  the  sheep  as  in  the  human  subject,  and  need  not,  therefore,  be 
dwelt  upon  in  this  place;  although  in  dissecting  the  brain  of  the  sheep, 
reference  may  be  very  advantageously  made  to  the  base  of  the  human 
brain  for  assistance  in  discriminating  several  of  the  particular  pairs  of 
nerves. 

We  have  now  seen  enough  of  the  anatomy  of  the  brain  of  the  lower 
animals  to  understand  how  we  ought  to  study  it  in  man  ;  we  have  traced 
it  from  a  most  simple  form  up  to  what  would  have  appeared  a  very  com- 
plex one  if  we  had  not  seen  all  the  connecting  links.  The  study  of 

par  F.  A.  Longet,  Laureat  de  1'Institute  de  France,  Academie  des  Sciences,  Doct.  en  Mede- 
cine  de  la  Faeulte  de  Paris,  Prof.  d'Anatomie  et  de  Physiologic,  Chirurgeon  de  la  Maison 
Koyale  de  Saint  Dennis,  &c.,  1842. 


Three  sections  of  the  me- 
dulla oblongata  of  the  sheep. 
— See  fig.  51.  F  F.  Auditory 
ganglion.  G.  Pneumogastrie 
ganglion,  s  s.  Olivary  body. 


PACHYDERMATA. 


109 


these  links  must  assist  us  in  the  study  of  the  human  brain.  In  a  mere 
anatomical  point  of  view  we  might  abandon  our  comparative  anatomy 
and  proceed  at  once  to  man  ;  but  in  a  physiological  and  philosophical 
point  of  view  we  shall  find  it  interesting  to  glance  at  the  characteristic 
features  of  the  brains  of  those  Mammalia  which  remain  undescribed  be- 
tween the  Ruminantia  and  the  human  race. 

The  Pachydermata  or  thick-skinned  animals  are  the  next  in  order,  of 
which  the  Horse  is  our  most  familiar  example  ;  fig.  53  is  taken  from 

Fig.  53. 


External  surface  of  the  brain  of  the  horse,  reduced  one-half.  (Leuret.)  s.  Fissura  Sylvii,  which  is 
bifurcated.  I,  II,  III.  Those  figures  which  are  placed  before  the  fissura  Sylvii  indicate  each  of  the  ante- 
rior convolutions;  and  I,  II,  III,  IV,  behind,  indicate  the  four  posterior  convolutions.  -4-.  Point  of  re-union 
of  the  posterior  convolutions  I  and  II  behind  the  fissure  of  Sylvius,  o.  Supra  orbital  convolution.  1  h. 
Hippocampal  lobe,  or  inferior  projection  of  the  internal  convolution,  c  g.  Corpus  geniculatum.  1,  2,  3, 
indicate  the  three  lobes  of  the  cerebellum,  e.  Olfactory  ganglion,  o.  Optic  nerve,  m.  Third  pair.  p. 
Fourth  ditto,  t.  Fifth  ditto,  u.  Sixth  ditto,  f.  Seventh,  facial.  I.  Eighth,  auditory,  g.  Ninth,  glosso- 
pharyngeal.  v.  Tenth,  par  vagum.  h.  Eleventh,  lingual,  s.  Twelfth,  spinal  accessory,  x.  Pons  Varolii. 

Fig.  54. 


Longitudinal  sectipn  of  the  brain  of  the  horse,  through  its  centre,  showing  its  internal  surface,  reduced 
one-half.  (Leuret.)  A.  Anterior  convolution,  p.  Posterior  ditto,  i.  Internal  ditto,  surrounding  the  cor- 
pus callosum,  united  to  the  anterior  convolution  before,  and  posteriorly  and  inferiorlyto  the  hippocampal 
lobe.  e.  Olfactory  ganglion,  c  c.  Corpus  callosum  divided  in  the  centre,  c  o.  Commissura  mollis.  g  p. 
The  letters  are  on  the  optic  thalamus,  the  line  leads  to  the  pineal  gland,  t  q.  Optic  tubercles ;  behind 
these  is  the  divided  cerebellum,  exhibiting  the  arbor  vitse. 

Leuret.  At  one  glance  the  student  will  perceive  that  the  brain  is  of  a 
high  character.  (The  drawing  is  reduced  one-half.)  The  cerebrum  is 
large,  and  the  convolutions  are  numerous.  It  is  rounder  and  more  ele- 
vated than  that  of  the  ox,  though  in  both  there  is  more  brain  anterior  to 


110 


COMPARATIVE    ANATOMY. 


the  corpus  callosum  than  behind  it.  It  covers  the  tubercula  quadrige- 
mina  and  a  part  of  the  cerebellum.  The  internal  parts  are  the  same  as 
in  the  sheep.  The  arrangement  of  cineritious  and  medullary  neurine  in 
the  cerebellum  is  the  same  as  in  man.  A  perpendicular  section  exhibits 
the  appearance  called  the  arbor  vitaB,  and  shows  an  immense  surface  of 
cineritious  neurine.  The  olfactory  ganglia  are  of  great  size,  as  also  their 
commissures  and  the  hippocampal  convolutions.  The  medulla  oblongata 
is  large  (see  fig.  55).  The  pyramidal  eminences  are  distinct ;  there  is 


Fig.  55. 


Fig.  5G. 


Fig.' 56. — Medulla  oblongata  of  the  horse.  Figures  the  same.  The  lines  are  numbered  to  indicate  the 
sections  exhibited  in  fig.  56.  No.  2  impinges  on  the  bifurcation  of  the  anterior  pillars.  T.  Corpus  pyra- 
midale.  \v.  Corpus  restiform.  u.  Cms  cerebri.  c.  Third  pair  of  nerves,  e.  Fifth  ditto.  /.  Sixth  ditto. 
The  line  crossing  the  medulla  transversely  below  the  root  of  this  nerve  marks  the  lower  edge  of  the  cor- 
pus trapezoidum.  g.  Seventh,  facial,  h.  Eighth,  auditory,  j.  Tenth,  par  vagum.  k.  Eleventh,  lingual. 

Fig.  56. — Sections  of  the  medulla  oblongata  of  the  horse.  For  position,  see  fig.  55.  Nos.  1.  4,  and  5 
have  been  placed  by  mistake  with  the  inner  or  mesial  edge  of  the  section  to  the  right  instead  of  to  the 
left,  as  in  Nos.  2  and  3.  G.  Pneumogastric  ganglion.  F.  Auditory  ganglion,  s.  Olivary  body. 

• 

no  appearance  of  corpora  olivaria  on  the  surface,  but  a  section  reveals 
them  clearly.  This  position,  as  compared  with  those  in  the  human 
being,  is  curiously  altered  (see  fig.  56,  Nos.  2  and  3).  This  fact  is  to 
me  a  convincing  proof  that  they  are  imbedded  in  the  motor  tract,  and 
that  they  do  not  form  any  line  of  physiological  demarkation.  I  have 
taken  a  great  deal  of  pains  to  work  this  matter  out,  and  ascertain  what 
is  the  homology  of  these  bodies.  The  conclusion  I  have  arrived  at  is, 


PACHYDERMATA. 


Ill 


that  they  are  the  ganglia  of  the  lingual  nerves,  and  that  the  great  extent 
of  cineritious  neurine  which  exists  in  them  in  man  has  relation  to  the 
multiplied  movements  of  the  organ  of  speech. 

There  are  objections  to  this  theory,  and  among  others  their  great  ex- 
ternal size  in  the   elephant  (see  fig.  57).     In  this  figure,  the  great  pro- 


Fig.  57. 


Medulla  oblongata  of  the  elephant ;  sketched  from  a  preparation  in  the  College  of  Surgeons.  8.  Corpus 
olivare,  T.  Corpus  pyramidale.  w.  Corpus  restiform.  x.  Pons  Varolii.  c.  Third  pair  of  nerves,  e. 
Fifth  ditto,  g.  Seventh,  facial,  h.  Eighth,  auditory,  i.  Ninth,  glosso-pharyngeal.  j.  Tenth,  par  vagum. 
k.  Eleventh,  lingual. 

jection  they  form  on  the  surface  of  the  medulla  is  very  well  shown  ;  and 
it  is  most  likely  that  this  projection  is  caused  by  a  great  quantity  of  gan- 
glionic  neurine  within :  but  without  a  section  this  cannot  be  positively 
asserted.  Again,  their  large  size  in  an  animal  whose  intelligence  ap- 
proaches nearer  to  that  of  the  human  being  than  that  of  any  of  the  lower 
animals,  is  curious  and  interesting.  The  olivary  bodies  are  very  distinct 
in  the  apes ;  but  in  some  Carnivora,  as  the  bears,  they  are  not  so  well 
formed ;  in  others,  as  the  lynx,  badger,  and  seal,  the  internal  border  is 


112  COMPARATIVE   ANATOMY. 

confounded  in  their  whole  length  with  the  pyramidal  bodies,  and  only 
distinguishable  by  the  origin  of  the  twelfth  pair  of  nerves.  (Cuvier, 
Lemons.) 

There  is  a  preparation  of  the  brain  of  the  elephant  in  the  Museum  of 
the  College  of  Surgeons,  1331,  but  it  is  not  sufficiently  dissected  to 
render  its  internal  anatomy  distinct.  Mr.  Owen  gives  an  account  of  it, 
and  from  that  the  following  is  taken.  It  is  an  interesting  account,  and 
confirms  an  opinion  I  advanced  many  years  ago,  that  the  hemispherical 
ganglion  is  positively  not  relatively  larger  in  man  than  in  any  other 
animal. 

The  absolute  size  of  this  organ  in  the  Asiatic  elephant  exceeds  that  of 
man.  But  the  proportion  which  the  cerebrum  bears  to  the  rest  of  the 
brain,  and  especially  that  part  of  the  hemisphere  which  forms  the  roof 
and  sides  of  the  lateral  ventricle,  is  much  less. 

"The  hemispheres  are  broad  and  short,  with  a  considerable  develop- 
ment of  the  natiform  protuberance.  The  convolutions  are  comparatively 
small  and  numerous.  The  anfractuosities  are  also  deep,  extending  in 
some  cases  more  than  two-thirds  of  an  inch  into  the  substance  of  the 
brain.  The  hippocampus  is  comparatively  smaller  than  in  the  ass,  and 
the  corpus  striatum  larger.  The  ventricle  is  continued  into  the  olfactory 
bulb.  The  cerebellum  is  of  considerable  width,  and  its  surface  increased 
by  numerous  and  complex  anfractuosities.  The  tuber  annulare  corre- 
sponds in  size  to  the  development  of  the  lateral  lobes  of  the  cerebellum. 
The  corpora  olivaria  are  remarkably  prominent.  The  olfactory  nerves  and 
the  fifth  pair,  which  supply  the  proboscis,  are  remarkable  for  their  pro- 
digious size;  whilst  the  optic  nerves,  and  those  which  supply  the  mus- 
cles of  the  eye,  are  as  remarkable  for  their  small  size." 

The  brain  of  the  Getacea,  which  form  the  next  group  in  the  animal 
kingdom,  must  now  engage  attention.  Of  this  class  the  porpoise  affords 
the  most  convenient  illustration.  This  creature,  which  to  the  vulgar  is 
no  more  than  a  large  fish,  the  enlightened  physiologist  admits  into  the 
same  grand  division  of  the  animal  kingdom  to  which  man  himself  be- 
longs. Bringing  forth  its  young  in  a  state  requiring,  long  after  birth,  the 
protecting  care  of  the  mother,  higher  intellectual  endowment  is  implied 
than  we  can  expect  in  fishes  and  reptiles,  whose  spawn  is  generally 
abandoned  by  the  parent  as  soon  as  it  is  shed,  and  in  accordance  with 
these  manifestations  of  higher  powers  we  find  the  cerebral  mass  deve- 
loped upon  the  same  plan,  and  presenting  nearly  the  same  appearances 
and  arrangement  of  parts,  as  some  of  the  most  perfect  of  the  terrestrial 
Mammalia,  and  even  as  the  brain  of  man  himself. 

Looking  at  the  superior  part  of  the  cerebral  mass  of  the  porpoise,  as 
represented  in  fig.  58,  we  observe  two  divisions,  the  cerebrum  (1)  and 
cerebellum  (7) ;  the  whole  surface  is  convoluted  as  in  the  human  brain, 
and  although  the  convolutions  are  smaller,  the  sulci  between  them  are 
of  considerable  depth;  its  shape  is  peculiar,  from  its  great  lateral  width 
as  compared  with  that  of  the  human  being  or  sheep,  for  the  cerebral 
hemispheres  taken  together  are  even  longer  from  side  to  side  than  from 
before  to  behind.  The  dimensions  of  the  cerebellum  are  great  in  com- 
parison with  those  of  the  cerebrum,  the  whole  cerebellum  bearing  a  pro- 
portion to  one  hemisphere  of  the  cerebrum  as  two  to  two  and  a  half. 


CETACEA. 


113 


Fig.  58. 


This  is  owing  to  the  great  size  of  the  lateral  lobes:  the  middle  lobe  or 
processus  vermiformis  is  small,  as  will  be  seen  by  fig.  58.  The  posterior 
lobes  appear  to  be  wanting,  as  in  the  sheep,  by  which  the  cerebellum  is 
left  partly  uncovered. 

The  great  transverse  commissure  or  corpus  callosum  (6)  is  strikingly 
short  from  before  back- 
wards, measuring  a  little 
more  than  one- fourth  of 
the  whole  length  of  the 
hemisphere,  if  we  except 
that  portion  which  curves 
downwards  in  front,  and 
which  is  about  a  third  of 
the  length  of  the  horizontal 
portion,  so  that  the  tuber- 
cula  quadrigemina  or  optic 
tubercles  (4  and  5)  are  en- 
tirely uncovered  by  it,  and 
on  removing  the  arachnoid 
and  pia  mater,  are  to  be  ob- 
served between  its  poste- 
rior edge  and  the  cerebel- 
lum, nearly  a  third  larger 
than  those  in  the  human 
brain  ;  the  posterior  pair, 
or  testes  (5),  are  nearly 
double  the  size  of  the  an- 
terior or  nates  (4). 

In  the  brains  of  the 
Mammalia  we  have  alrea- 
dy examined,  the  Rodentia,  Ruminantia,  Pachydermata,  we  found  the 
relative  size  of  the  optic  tubercles  the  same  as  in  man,  viz.,  the  anterior 
larger  than  the  posterior;  but  generally  in  the  Cetacea  and  Carnivora  the 
posterior  are  the  largest.  The  kangaroos  resemble  the  herbivorous  Mam- 
malia in  this  respect. 

The  pineal  gland  (9)  is  small  but  distinct,  as  well  as  its  commissure. 
A  perpendicular  section  having  been  made  through  the  transverse  com- 
missure a  little  to  the  left  side  of  the  mesial  line,  and  a  horizontal  one 
carried  through  one  of  the  hemispheres  on  a  level  with  it,  the  thalamus 
nervi  optici(3)  and  corpus  striatum(2)  are  exposed,  the  latter  scarcely 
a  fourth  part  as  large  as  the  former.  The  fornix,  which  is  small,  has 
been  divided,  and  with  the  exception  of  its  anterior  pillars  and  the  sep- 
tum lucidum,  removed  in  making  the  above  section.  There  is  no  pos- 
terior cornu  to  the  lateral  ventricle. 

The  plexus  choroides  is  very  peculiar,  being  transversely  folded,  like 
the  branchiae  of  a  bivalve  (see  Preparation  1332,  College  Museum). 

Has  this  arrangement  of  blood-vessels  special  relation  to  the  brain,  or 
is  it  merely  a  part  of  those  arterial  plexuses  which  are  found  so  large  in 
the  thorax,  and  exist  in  the  spinal  canal  and  about  the  head,  as  reservoirs 


Brain  of  the  porpoise,  half  of  the  left  hemisphere  removed, 
opening  the  lateral  ventricle.  1.  Section  of  the  left  hemi- 
sphere, exposing  the  left  ventricle,  containing — 2.  Corpus 
striatum,  or  anterior  cerebral  ganglion  ;  the  line  between  this 
and  the  next  is  not  very  distinct.  3.  The  posterior  cerebral 
ganglion  or  optic  thalamus.  4.  The  anterior  quadrigeminal 
bodies,  optic  tubercles,  or  nates.  5.  The  posterior  quadrige- 
minal bodies,  optic  tubercles  or  lestes.  6.  Great  transverse 
commissure,  or  corpus  callosum.  7.  Cerebellum.  8.  Spinal 
cord.  9.  Pineal  gland. 


114 


COMPARATIVE    ANATOMY. 


of  arterial  blood  for  the  animal  when  diving?    A  similar  arrangement 
exists  in  the  whale. 

Base  of  the  Brain  (see  fig.  59). — The  fissura  Sylvii  (s)  is  deep ;  the 
middle  lobe  very  large,  and  projecting  more  than  in  the  sheep.  But  the 
hippocampal  convolutions  are  much  smaller,  and  do  not  present  the 
same  distinctness. 

The  pons  Varolii  or  commissure  of  the  cerebellum  (p  v)  is  large  in 
proportion  to  the  whole  cerebral  mass,  and  is  about  the  same  size  as  this 
part  in  man,  according  with  the  great  development  of  the  lateral  lobes 
of  the  cerebellum. 

The  medulla  oblongata  presents  more  points  of  interest  and  instruction 
than  any  other  part.  In  the  first  place  it  is  more  than  double  the  size  of 
the  spinal  cord,  a  circumstance  which  partly  depends  on  the  large  size 
of  the  corpora  olivaria,  and  partly  on  the  magnitude  of  the  posterior 
pyramidal  bodies. 

The  corpora  olivaria  (H)  are  so  amazingly  developed,  that,  instead  of 
being  separated  from  each  other,  as  in  the  human  being,  by  the  corpora 
pyramidaHa,  they  overlap  and  cover  these  so  completely  as  even  to 
come  into  contact  with  each  other  in  the  median  line  (see  fig.  59). 

The  lingual  nerves  are  not 
of  proportional  size,  but  the 
pneumogastric  nerves  are 
about  double  the  size  of 
those  of  man.  If  the  cor- 
pora olivaria  be  carefully 
elevated,  the  anterior  col- 
umns of  the  spinal  cord 
will  be  seen  decussating 
beneath  and  posterior  to 
them. 

The  arrangement  of  the 
fibres  of  the  anterior  and 
posterior  columns,  as  re- 
gards their  course  towards 
the  cerebellum,  and  the 
share  they  take  in  the  for- 
mation of  the  corpora  resti- 
formia,  is  perfectly  identical 
with  the  disposition  of  the 


Fig.  59. 


Base  of  the  brain  of  the  porpoise.  (Leuret.)     This  figure 
exhibits  the  absence  of  olfactory  nerves,  the  large  size  oi  the 
pons  Varolii,  also  the  olivary  bodies,  and  their  juxtaposition 
ial  line.  oo.  Orbital  convolution,  p.  c.  Cruscerebri. 


on  the  mesia 

p  v.  Pons  Vurolii. 


s.  Fissura  Syl 
r   convolutio 
o.  Optic  nerve. 


the   antero-posterior   convolutions. 
Olivary  bodies, 


L  A.  Anterior  portion  of 
IP.   Posterior  ditto.      H. 


same  parts  in  the  human 
brain,  which  will  be  found 
described  so  fully  further 
on,  that  it  will  be  unneces- 


sary to  dwell  upon  it  here.  The  accordance  is,  nevertheless,  extremely 
interesting  as  confirming  those  views  I  have  advanced  on  the  subject  of 
the  communications  between  certain  parts  of  the  medulla  oblongata  and 
the  cerebellum. 

Origin  of  the  Nerves  in  the  Porpoise.— The  olfactory  nerves  are  en- 
tirely absent. 

The  optic  are  smaller  than  those  of  man;  their  origin  is  the  same. 


CARNIVORA. 


. 


115 


The  3d,  4th,  5th,  and  6th,  are  also  exactly  similar. 

The  7th,  or  facial,  is  the  same  both  in  size  and  origin. 

The  8th,  or  auditory,  is  nearly  double  the  size  of  that  in  the  human 
being. 

The  9th,  or  glosso-pharyngeal,  is  large. 

The  10th,  or  par  vagum,  is  at  least  double  the  size  it  presents  in 
man. 

The  spinal  accessory  is  rather  small.  Its  origin  is  the  same  as  in 
man. 

The  llth,  or  lingual,  is  rather  large.  Its  origin  is  from  the  anterior 
columns  of  the  cord  close  to  the  corpora  olivaria. 

In  the  different  genera  of  Whales,  John  Hunter  tells  us  that  the  brain 
differs  much  in  size.  The  thalami  are  large,  but  the  corpora  striata  are 
small.  The  fibrous  neurine  of  the  hemispheres  may  be  distinctly  traced 
through  the"  inner  layers  of  the  hemispherical  ganglion. 

In  the  piked  whale  the  whole  brain  was  found  to  weigh  four  pounds 
and  ten  ounces. 

The  Carnivora  form  the  next  group  in  the  animal  kingdom,  consisting 
of  the  bears,  martens,  dogs,  cats,  and  seals.  The  number  of  ganglia  and 
commissures  constituting  the  encephalon  of  these  animals  is  the  same  in 
all.  There  is  no  great  peculiarity  as  regards  their  relative  size.  In  the 
common  cat  (see  fig.  60),  the  olfactory  ganglia  (e),  as  we  might  expect, 

Fig.  60. 


Side  view  of  the  brain  of  the  common  cat.  (Leuret.)  e.  Olfactory  ganglia.  0.  Optic  nerve.  A  A  A. 
Anterior  portion  of  longitudinal  convolutions,  p  p  p.  Posterior  of  ditto,  s  is  opposite  the  fissura  Sylvii; 
a  line  from  s  divides  these  two  sets  of  convolutions,  -f-.  Union  of  the  two.  o.  Orbital  convolution. 

are  enormous.  The  hippocampal  lobes  are  also  large.  The  hemi- 
spheres cover  the  optic  tubercles,  and  partly  overlap  the  cerebellum. 
The  hemispherical  ganglion  is  much  convoluted.  The  convolutions  are 
described  further  on.  The  anterior  and  posterior  quadrigeminal  bodies 
are  of  nearly  equal  size,  the  anterior  being  rather  the  longest  from  before 
backwards.  "  In  the  lion  the  posterior,  though  smaller  in  longitudinal 
diameter,  are  broader,  and  rise  above  the  level  of  the  anterior  pair." — 
(Owen.)  In  the  seal  the  olfactory  ganglia  are  small,  but  not  absent,  as 
in  the  Cetacea,  though  the  form  of  the  brain  resembles  in  its  roundness 
that  of  these  creatures.  The  hemispheres  do  not  entirely  cover  the  cere- 
bellum, which  is  large,  especially  its  lateral  lobes.  The  corpora  oliva- 
ria maintain  the  same  central  position  as  in  the  porpoise,  but  they  do 
not  project  on  the  surface.  The  corpus  trapezoidum.,  that  oblong  por- 
tion of  the  medulla  oblongata  running  transversely  inferior  and  parallel 


116 


COMPARATIVE    ANATOMY. 


Fig.   61. 


Side  view  of  the  brain  of  the  hedge- 
hog. A.  Olfactory  ganglion.  B.  Hemi- 
spherical ganglion.  E.  Cerebellum. 
H.  Spinal  cord. 


Fig.  62. 


to  the  pons  Varolii,  between  the  fibres  of  which  facial  and  auditory 
nerves  emerge,  is  of  remarkable  size  in  all  the  genus  Fells. — (Owen.) 
In  the  group  Insectivora,  hedgehogs,  moles,  &c.,  the  brain  retrogrades, 
as  will  be  seen  by  referring  to  fig.  61,  which 
represents  the  brain  of  the  hedgehog.  The 
olfactory  ganglia  (A)  are  enormous  compared 
with  the  hemispheres.  The  hippocampal 
lobes  are  very  large,  corresponding  with  the 
olfactory  ganglia.  The  hemispherical  gan- 
glia are  quite  smooth  and  free  from  convolu- 
tions ;  the  cerebellum  is  large  and  well  de- 
veloped. 

The  Cheiroptera,  or  hand-winged  animals, 
the  bats,  come  next.  The  brain  of  the  bat  (fig.  62)  closely  resembles 
in  outward  appearance  that  of  the  bird.  The  olfactory  ganglia  (A)  are 

larger,  but  the  hemispheres  (B)  are  very  small 
and  smooth ;  the  cerebellum  is  peculiarly 
large. 

Next  to  the  Cheiroptera  below,  and  to  Man 
above,  we  have  the  Quadrumana,  the  lemurs, 
baboons,  apes,  and  monkeys.  No  general 
observations  will  describe  the  characteristics 
of  the  brain  in  this  class  beyond  what  apply 
to  the  Mammalia  generally  :  for  the  brain  of 
the  highest,  namely,  the  chimpanzee,  ap- 
proaches nearly  to  that  of  man  ;  while  some  of  the  lowest  appear  to  be 
little  raised  above  those  of  the  rodents  and  insectivora,  as  regards  the 
convolution  of  its  surface. 

Mr.  Owen,  in  his  paper  on  the  Marsupiata,  already  referred  to,  gives 
a  drawing  of  the  brain  of  a  monkey  (Midas  rufimanus}\  the  surface  of 
whose  brain  is  smooth,  with  the  exception  of  one  short  longitudinal  fis- 
sure extending  but  a  short  distance  on  the  hemisphere  from  before  back- 
wards:  at  the  same  time  it  must  be  stated  that  this  brain  is  above  that 
of  the  rodents,  &c.,  inasmuch  as  it  covers  the  cerebellum. 

The  outline  of  the  brain  of  Mammalia,  as  viewed  from  above,  presents 
three  principal  varieties.  In  one  it  is  almost  circular — this  includes  the 
ourang  outang,  the  seal,  and  the  porpoise.  In  another  it  is  oval,  more 
or  less  elongated,  as  in  the  lion,  beaver,  and  sheep.  While  in  a  third 
it  is  almost  triangular  or  heart-shaped,  the  anterior  lobes  being  remark- 
ably narrow,  as  in  the  ferret,  in  the  opossum,  and  in  the  rabbit.  The 
forms  have  no  relation  to  the  different  orders  of  the  Mammalia,  as  the 
examples  which  have  been  mentioned  show.* 

There  are  a  few  parts  of  the  encephalon  on  which  I  have  thought  it 
well  not  to  say  much  in  the  description  of  the  brain  individually,  but 
which  it  may  be  well  to  consider  collectively. 

Corpora  Geniculata. — The  tubercles  which  will  be  pointed  out  in  man 
as  forming  a  third  pair,  under  the  name  of  the  corpora  geniculata  interna, 
become  in  monkeys,  in  dogs,  and  in  other  Carnivora,  as  large  as  those 


Side  view  of  the  brain  of  the  bat. 
A.  Olfactory  ganglion.  B.  Hemi- 
spherical ganglion.  E.  Cerebellum. 
H.  Spinal  cord. 


*  Cuvier,  Le9ons,  2d  eel.,  1845. 


'  .:    .  ,'       . 

» 


VENTRICLES.  H7 


of  the  other  pairs  ;  but  they  are  small  or  scarcely  visible  in  the  Rumi- 
nantia.  They  are  very  large  in  the  horse,  and  always  joined  to  the  testes 
by  a  strong  fibrous  fasciculus,  which  appears  to  pass  under  the  optic 
nerve  and  terminate  in  the  optic  thalarai.  In  the  monkeys,  especially 
in  the  ourang  outang  and  the  baboon,  we  find  the  corpora  geniculata  in- 
terna  also  receiving  a  fasciculus  from  the  nates,  and  giving  out  a  root 
which  runs  low  enough  to  unite  itself  with  the  principal  cord  of  the  optic 
nerve. 

The  corpora  geniculata  externa  are  much  less  constant  than  the  in- 
terna,  and  their  projection,  already  much  effaced  in  the  monkey,  is  no 
longer  distinguished  in  the  other  classes  from  the  projection  of  the  optic 
thalamus  under  the  ribbon  of  the  nerve  which  conceals  it. 

Optic  Thalami. — The  size  of  these  ganglia,  the  optic  thalami,  appears 
to  be  in  direct  relation  with  the  size  of  the  folds  of  the  hemispheres. 
This  is  especially  observable  in  the  dolphin,  where  the  hemispheres  are 
of  considerable  size  and  thickness. 

The  pineal  gland  does  not  present  any  remarkable  difference.  It  is 
sometimes  elongated  into  a  cylinder,  as  in  the  ox  and  the  seal ;  some- 
times triangular,  prismatic,  or  cordiform,  as  in  the  sheep  and  the  horse ; 
or  conical,  as  in  the  monkey:  it  is  generally  small  in  the  Garni vora.  Its 
fasciculi,  from  their  origin  on  the  upper  surface  of  the  optic  thalami  to 
the  anterior  commissure,  may  be  distinctly  traced.  In  the  opossum,  the 
fasciculi  at  the  origin  of  the  gland  are  large,  and  form  a  projection  on 
the  superior  edge  of  the  optic  thalami.  Many  anatomists  affirm  to  never 
having  met  with  earthy  concretions  in  any  animal,  analogous  to  those 
which  are  seen  in  the  pineal  gland  in  man. 

Corpora  Striata. — These  bodies  scarcely  differ,  in  all  the  Mammalia, 
except  in  size ;  they  are  separated  from  the  optic  thalami  by  a  very  marked, 
and  sometimes  by  a  very  deep,  furrow,  in  which  are  lodged  the  taenia 
semicircularis  and  the  pillar  of  the  fornix,  and  their  size  is  in  general  very 
similar  to  that  of  the  optic  thalami.  In  the  dolphin,  however,  the  dis- 
proportion is  considerable;  the  corpus  striatum  is  much  less  prominent 
and  less  voluminous  than  the  optic  thalamus. 

Corpus  Callosum,  Fornix,  and  Hippocampal  T^be. — The  corpus  callo- 
sum  and  the  fornix,  like  the  striated  bodies,  do  not  differ  much  in  size. 
The  hippocampal  lobes  are  generally  larger  in  proportion  in  Mammalia, 
but  their  surface  does  not  present  the  same  swollen  appearance  as  in  man. 
The  corpus  callosum,  in  some  instances,  seems  to  be  developed,  as 
regards  its  size,  in  relation  to  the  corpus  striatum  ;  as  we  have  already 
seen  in  the  brain  of  the  porpoise,  which  has  large  hemispheres,  a  pro- 
portionally small  and  thin  corpus  callosum,  and  a  very  moderately-sized 
corpus  striatum. 

Ventricles. — There  is  no  digital  cavity  in  the  lateral  or  anterior  ven- 
tricles, except  in  man  and  the  apes.  Its  presence  depends  on  that  of  the 
posterior  lobes;  but  in  the  seals  and  dolphins,  where  the  posterior  part  of 
the  hemisphere  is  considerable,  it  descends  into  the  temporal  fossa,  thus 
exhibiting  a  rudiment  of  the  digital  cavity  in  the  brain  of  man. 

The  lateral  ventricle,  in  most  Mammalia,  is  continued  anteriorly  into 
the  hollow  tube  of  the  olfactory  commissure,  the  third  and  fourth  ven- 
tricles not  presenting  any  remarkable  difference. 


118  COMPARATIVE   ANATOMY. 

The  mammary  tubercles  are  often  very  distinct,  as  in  the  Callitrix,  one 
of  the  squirrel-monkeys,  the  lion  and  the  lynx :  they  are  more  frequently 
blended  into  one,  as  in  the  hyrax,  stag  and  lama.* 

It  has  been  already  explained  that  the  convoluted  hemispherical  gan- 
glia are  the  parts  with  which  the  intellectual  powers  are  more  immediately 
connected;  and  as  the  ganglia  increase  in  size,  they  become  altered  from 
mere  rounded  points,  like  peas,  to  folded  surfaces.  The  principal  change 
which  we  have  to  observe  in  tracing  the  form  of  the  brain  from  the 
Rodentia  up  to  Man,  is  in  the  relative  proportion  of  the  hemispherical  to 
the  rest  of  the  cerebral  ganglia,  and  in  the  size,  number,  and  direction 
of  the  convolutions.  It  is  stated  by  Leuret,f  that  the  cerebral  convolu- 
tions of  the  Mammalia  are  alike  in  the  same  animal,  and  that  the  Mam- 
malia may  be  classified  by  the  similitude  of  their  cerebral  convolutions. 
The  classification  which  is  founded  upon  these  convolutions  differs  in 
many  essential  points  from  that  which  is  based  upon  the  form  of  their 
organs  of  prehension ;  it  associates  animals  of  corresponding  faculties, 
and  separates  those  which  differ  in  this  respect.  The  cerebral  convolu- 
tions have  many  well-marked  types,  which  may  easily  be  traced  one 
into  the  other. 

No  portion  of  the  study  of  the  brain  is  at  first  sight  so  unpromising, 
unsatisfactory  and  puzzling,  as  that  of  the  convolutions  ;  they  appear  so 
complicated,  indefinite,  confused,  and  countless,  that  few  can  be  induced 
even  to  consider  the  subject.  If,  however,  they  will  take  the  trouble 
to  investigate  it  a  little,  they  will  be  rewarded,  by  finding  it  much  more 
simple  than  it  at  first  sight  appears. 

In  order  to  understand  the  various  forms  which  the  convoluted  surface 
of  the  brain  assumes  in  different  animals,  we  will  suppose  the  hemispheres 
to  be  a  flat  layer  of  soft  material,  such  as  a  piece  of  putty;  but  as  this 
is  not  always  at  hand  for  the  purposes  of  illustration,  take  a  piece  of  cloth, 
and  a  small  lozenge-box.  In  the  lowest  animals  the  brain  is  smooth : 
to  imitate  this,  the  cloth  may  be  cut  the  size  of  the  box,  and  it  will  go 
in  without  folding,  and  be  smooth  like  the  brain  of  the  rat  or  hedgehog. 
But  a  little  higher  in  the  scale  of  animals,  as  in  the  agouti,  for  instance, 
the  surface  is  not  quite,  smooth ;  there  is  one  slight  longitudinal  furrow 

(fig.  63).  We  may  now  cut  the  cloth  a  little 
larger  than  the  box,  and  one  very  slight  fold 
is  sufficient  to  get  it  in.  A  little  higher  in  the 
animal  scale,  and  we  find  two  or  three  folds, 
but  all  still  in  the  longitudinal  direction  ;  in 
the  same  way  then  to  imitate  these,  the  cloth 
must  be  cut  still  larger,  and  folded  longitudi- 
nally. Still  rising  in  the  scale,  the  brain  goes 
on  increasing ;  we  must  now,  therefore,  as 
the  additional  size  is  given  by  additional 
length,  make  transverse  as  well  as  longitudi- 
nal folds.  Suppose  a  surface  to  have  been 
folded  thus,  like  the  upper  figure,  but  which 
cannot  be  packed  in  the  box  because  it  is  a 

*  Cuvier,  Le$ons,  vol.  iii.  p.  99,  2d  ed,  1845.  f  Op.  cit.,  vol.  i.  p.  451.] 


CONVOLUTIONS.          .  119 

little  too  long  for  it;  we  then  bend  it  a  little  in  the  opposite  direction: 
the  effect  would  thus  be  to  produce  a  transverse  furrow,  as  in  the  lower 
figure  ;  and  this,  in  fact,  is  the  next  step  in  the  complication  of  the 
convolutions.  At  first,  these  folds  are  very  short,  and  only  connect  the 
longitudinal  folds  together;  but  in  the  higher  animals,  elephants,  apes, 
and  man,  they  are  so  large  that  they  divide  the  longitudinal  convolutions. 

We  may  now  turn  to  the  anatomical  facts,  and  see  if  we  can  realize 
and  digest  them ;  and  we  do  so  the  easier  for  the  above  most  homely 
illustration  ;  I  trust  it  will  be  forgiven,  even  by  those  who,  unlike  the 
author,  could  have  understood  them  without  some  such  clue  to  their 
meaning. 

These  explanations  will,  I  think,  be  easily  understood  as  we  proceed, 
by  referring  to  the  following  figures,  taken  from  Leuret.  To  assist  in 
remembering  the  course  of  the  convolutions,  and  their  variety  in  different 
species,  we  may  consider  the  longitudinal  foldings  as  the  result  of  pres- 
sure from  above  and  below;  the  transverse  foldings,  from  before  and 
behind. 

It  is  a  curious  coincidence,  to  say  the  least  of  it,  that  as  the  longest 
heads  in  the  human  species  contain  the  most  active  and  intellectual  brains, 
so  is  the  greatest  advance  from  the  lower  form  of  brain  to  the  higher 
made  by  lengthening  the  brain,  as  shown  by  the  transverse  foldings.  It 
is  an  old  saying,  and  a  true  one,  in  speaking  of  a  clever  man,  "  He  is  a 
long-headed  fellow." 

Professor  Owen,  in  a  paper  communicated  to  the  Zoological  Society 
as  far  back  as  1833,  began  a  classification  of  the  convolutions  of  the 
brain.  His  paper  was  simply  entitled,  uThe  Anatomy  of  the  Cheetah, 
Felisjubata."  He  continued  his  observations  to  the  feline  and  canine 
race.  They  are  very  clear,  and  point  out  the  same  longitudinal  furrow- 
ing which  was  afterwards  described  by  Leuret,  as  will  be  shown  further 
on.  I  have  thought  it  better  to  follow  the  latter,  as  his  descriptions  are 
more  extended,  and  quite  confirm  the  observation  of  Professor  Owen, 
who  observes,  that  the  constancy  manifested  in  the  disposition  of  the 
convolutions,  as  to  their  form,  extent,  and  symmetrical  arrangement, 
argues  strongly  in  favor  of  the  conclusion  that  the  folding  of  the  hemi- 
spherical substance  in  the  progress  of  development  follows  a  determinate 
law. 

A  classification  of  animals  in  relation  to  their  convolutions,  will  be  found 
to  accord  with  the  extent  of  their  intelligence;  animals  may  be  divided 
into  groups,  in  accordance  with  the  form  of  their  convolutions. 

Thejirst group  includes  animals  taken  from  different  families,  viz.,  the 
Cheiroptera  or  Bats  (fig.  62),  the  Insectivora  (61),  the  Marsupiata  (fig.  40), 
the  Monotremata,  and  especially  the  Rodentia  (41,  47).  They  correspond, 
as  regards  the  absence  of  convolutions,  to  those  birds  which  have  but 
little  intelligence. 

In  the  second  group  there  are  still  no  convolutions,  but  there  are 
depressions  which  announce,  as  it  were,  their  approach.  The  animals 
which  compose  this  group  are  from  the  Rodentia,  the  Insectivora,  and 
the  Marsupiata.  Besides  the  fissura  Sylvii,  which  is  here  more  promi- 
nent than  in  the  first  group,  there  are  depressions  upon  the  cerebral  lobe 


120 


COMPARATIVE   ANATOMY. 


Fig.  63. 


Upper  surface  of  the  brain  of 
the  agouti.  (Leuret.)  Slight  trac- 
ing of  the  longitudinal  convolu- 
tions. A.  Olfactory  ganglia.  B. 
Hemispherical  ganglia.  E.  Ce- 
rebellum. H.  Spinal  cord. 


which  have  a  certain  regularity,  as  may  be  seen  in  the  examination  of 
the  brain  of  the  hare  and  agouti. 

On  each  side  of  the  median  furrow,  which 
extends  from  before  to  behind,  we  see  a  parallel 
furrow  which  circumscribes  a  portion  of  cere- 
bral substance,  having  almost  the  aspect  of  a 
convolution:  this  is  well  seen  in  the  agouti 
(fig.  63).  In  the  beaver  (see  fig.  40)  we  see  some 
furrows  less  prolonged  but  more  deep,  having 
the  same  direction  as  those  in  the  hare  and 
agouti.  Gall  and  Spurzheim  were  in  error 
when  they  stated  that  the  number  of  convolu- 
tions is  in  relation  to  the  volume  of  the  brain; 
for  instance,  in  the  brain  of  the  ferret  there  are 
five  convolutions  very  distinct,  three  external, 
one  internal,  an  anterior  or  supra-orbital ;  yet  the 
brain  is  not  equal  to  that  of  the  squirrel,  which  is 
without  convolutions  or  furrows,  and  it  is  much 
inferior  to  that  of  the  hare,  of  the  porcupine,  of 
the  paca,  agouti,  beaver,  &c.  These  latter  have 
a  brain  more  voluminous  than  the  ferret  and  the 
polecat.  Nevertheless,  it  is  generally  true  that 
those  species  of  animals  which  have  the  most 
voluminous  brains,  have  also  the  convolutions 
and  undulations  most  numerous  and  varied. 

M.  Leuret  illustrates  his  views  regarding  the  cerebral  convolutions  by 
a  demonstration  of  the  convolutions  of  the  brain  of  the  fox  (see  fig.  64), 
exhibiting  the  external  face  of  the  right  hemisphere  of  the  brain  :  s, 

marks  a  deep  furrow,  pass- 
ing obliquely  upwards  and 
backwards — the  fissuraSyl- 
vii.  There  is  a  rounded 
body  surrounding  this  fis- 
sure— this  is  the  first  con- 
volution ;  a  second,  third, 
and  fourth,  are  placed  one 
above  the  other,  making 
four  convolutions;  before 
these,  placed  in  front,  there 
is  a  fifth  (o),  the  supra-orbi- 
tal. The  sixth,  and  last 
(i),  forms  at  the  under  part 
of  the  middle  lobe  the  hip- 
pocampal  convolution.  If 
we  compare  this  brain  with  that  of  the  bear,  we  find  that  the  fissura  Syl- 
vii  is  larger,  but  there  is  the  same  proportion  to  the  rest  of  the  brain. 
Instead  of  there  being  four  lateral  convolutions,  as  in  the  fox,  there  are 
only  three,  though  at  first  sight  the  brain  appears  more  complicated. 
Fig.  65,  representing  the  upper  surface  of  the  brain  of  the  fox,  shows 


Brain  of  the  fox.  (Leuret.)  e.  Olfactory  ganglia,  o.  Optic 
nerve,  o.  Orbital  convolution.  A  A  A.  Anterior  ditto.  P  P  P. 
Posterior  ditto,  s  s.  Fissura  Sylvii.  1  2.  Cerebellum. 


CONVOLUTIONS. 


121 


Fig.  65. 


Upper  surface  of  the  brain  of  the  fox.    (Leuret.) 
Fissura  Sylvii. 


the  completion  of  the  fourth  convolution,  of  which  fig.  64  shows  the 
internal  and  posterior  part. 

The  third  group  contains  the  fox,  wolf,  &c.  The  convolutions  of  the 
brain  of  the  wolf  are  the  same 
in  number  as  those  of  the  fox, 
only  there  are  more  numerous 
depressions,  and  a  very  pro- 
longed furrow  upon  the  third 
external  convolution,  in  the  spot 
where  in  the  fox  there  is  only  a 
rudiment  of  a  depression.  Leu- 
ret  states  that  he  has  compared 
the  brains  of  dogs  of  different 
species,  and  he  has  always  found 
the  same  type,  the  same  convo- 
lutions, without  any  difference 
but  in  the  number  of  the  depres- 
sions, and  extent  of  the  undu- 
lations ;  this  difference  corre- 
sponds to  the  volume  of  the 
brain. 

Fourth  group. — All  animals 
of  the  genus  Cat  and  Hyena  are 
comprised  in  this  group.  As  in 
the  preceding  group,  the  smaller 
the  brain,  the  fewer  the  convolutions  and  depressions.  There  are  many 
essential  differences  with  regard  to  the  cerebral  convolutions  between 
the  fox  tribe,  which  includes  the  dogs,  and  waives,  and  the  cats.  In 
these  latter  (fig.  60),  we  find  four  external  longitudinal  convolutions,  one 
internal,  and  one  supra-orbital.  But,  contrary  to  the  arrangement  in  the 
brain  of  the  foxes,  these  convolutions  have  many  points  of  union,  which, 
I  believe,  arises  from  the  greater  length  of  the  ganglion  requiring  it  to 
be  pushed  up  together  in  its  long  axis :  at  the  place  marked  s  in  fig.  60, 
there  is  a  furrow,  which  represents  the  fissura  Sylvii ;  this  furrow  is  very 
much  developed  in  the  panther,  in  the  lion,  and  all  the  large  species  of 
this  genus. 

Fifth  group. — They  are  varied,  but  they  have  this  common  point  of 
resemblance — that  the  number  is  only  five,  three  external,  one  supra- 
orbital,  and  the  fifth  internal. 

The  civet  forms  a  very  natural  and  easy  transition  between  the  bears 
and  the  foxes.  The  genet  forms  a  transition  between  the  brain  of  the 
civet  and  that  of  the  marten. 

In  the  coati  there  are  but  three  external  convolutions  ;  the  first  is  of 
unequal  size  in  different  parts  of  its  extent :  behind  the  fissura  Sylvii  it 
is  very  much  enlarged;  above  that  fissure  it  recedes  upon  itself,  and  re- 
mains partly  below  the  anterior  portion  of  the  second  convolution.  The 
same  disposition  is  met  with  in  the  weazel,  the  marten,  the  otter,  and 
the  bear. 

The  second  convolution  is  in  an  inverse  ratio  to  the  first,  being  larger 
before  than  behind. 


122  COMPARATIVE    ANATOMY. 

The  third  convolution,  simple  and  regular  in  the  ferret,  has  in  the 
polecat  a  fissure  behind,  which  is  replaced  on  the  two  sides.  The  coati 
has  more  depressions.  Viewing  the  brain  of  the  ferret,  weazel,  coati, 
badger,  and  polecat,  above,  a  transverse  fissure  may  be  seen  to  cut  the 
mesial  fissure,  like  the  letter  V.  The  convolution  in  front  of  this  fissure, 
which  forms  the  anterior  point  of  the  brain,  is  a  portion  of  the  internal 
convolution,  which,  commencing  at  the  hippocampal  lobe,  runs  back- 
wards, embraces  the  corpus  callosum,  and  rising  anteriorly  to  unite  with 
the  superior  convolution.  Above  the  orbit  is  the  last  convolution,  the 
supra-orbital ;  it  is  furrowed  for  the  olfactory  commissure. 

The  brains  of  the  fifth  group  form  a  sort  of  transition  between  the 
foxes  and  the  sheep. 

The  sixth  group  includes  only  the  ichneumons. 

The  seventh  group  includes  the  two-toed  sloth,  the  ai  or  three-toed 
sloth,  the  African  ant-eater,  phascolomys  or  wombat,  and  the  hyrax  or 
coney.  In  none  of  the  animals  composing  this  group  do  we  meet  with 
a  single  transverse  furrow. 

The  eighth  group  includes  the  pteropus,  or  fox-like  bat,  kangaroo, 
orycteropus. 

Ninth  group. — The  brain  of  the  genus  Sheep,  including  the  Ruminan- 
tia  (figs.  49  and  50),  which  forms  the  ninth  group,  has  in  reality  only 
four  convolutions  ;  one  internal,  one  infra-orbital,  two  external,  which 
have  numerous  divisions,  some  depressions,  and  a  form  very  undulating. 
It  is  a  sort  of  amplification  of  the  brain  of  the  orycteropus. 

The  convolutions  of  this  group,  in  their  general  aspect,  do  not  resem- 
ble those  of  the  foxes,  cats,  or  bears  ;  they  have  more  analogy  to  the 
convolutions  in  the  human  brain.  Viewed  above,  we  observe  the  lon- 
gitudinal foldings  much  doubled  up,  so  as  to  produce  many  transverse 
folds. 

We  cannot  attempt  to  follow  out  all  the  minute  varieties  in  the  con- 
volutions of  the  tenth,  eleventh,  and  twelfth  groups  of  M.  Leuret,  which 
includes  the  pigs,  the  seals,  and  the  Cetacea,  but  proceed  to  the  thir- 
teenth group.  With  the  exception  of  suborbital  convolutions,  the  con- 
volutions of  the  brain  of  animals  below  this  group  are  all  directed  from 
before  to  behind — they  traverse  the  brain  longitudinally.  Between  these 
convolutions  in  many  brains  there  are  points  of  union,  a  sort  of  solder- 
ing or  joint ;  they  are  found  in  the  cat,  bears,  otter,  sheep  (fig.  49), 
&c.  ;  but  all  are  parallel,  none  are  placed  transversely  to  the  brain,  cut- 
ting the  longitudinal  convolutions  into  two  parts,  and  dividing  them 
into  anterior  and  posterior  convolutions.  This  division  of  the  longitudi- 
nal convolutions,  this  addition  of  new  convolutions,  is  found  only  in  the 
elephant,  the  apes,  and  in  man  (see  figs.  66  and  67,  and  the  descrip- 
tions). 

Fourteenth  group. — In  the  apes,  and  especially  the  monkeys,  the  con- 
volutions are  not  so  undulating  and  voluminous  as  in  the  elephant  and 
whale  ;  thus  they  appear  at  first  sight  to  be  further  from  man  than  the 
latter  :  but  a  little  attentive  observation  soon  dispels  this  illusion.  The 
general  form  of  the  brain  of  the  monkey,  its  development  behind,  the 
extent  and  degree  of  inclination  of  the  fissura  Sylvii,  form  a  brain  as  an 
embryonic  perfectioning  of  the  brain  of  man,  whilst  the  brain  of  the  ele- 


CONVOLUTIONS. 


123 


pbant,  and  especially  that  of  the  whale,  considered  in  their  different  rela- 
tions, descend  towards  the  form  of  the  brain  of  other  Mammalia. 


Fig.  66. 


IICA 


Internal  surface  of  the  right  hemisphere  of  the  Indian  elephant.  (Leuret.)  c  c.  Corpus  callosum.  nil. 
Internal  convolution.  This  convolution,  above  and  behind  the  corpus  caHosum,  sends  a  prolongation,-}-, 
which  is  united  to  the  superior  convolutions,  s  s  s  s.  Leuret  states  that  he  has  never  met  with  this  disposi- 
tion of  the  convolutions,  except  in  man,  the  ape,  and  in  the  elephant.  This  portion  cuts  the  antero-poste- 
rior  convolutions  into  two  portions,  of  which  some  are  anterior  and  the  others  posterior,  m.p,  III.P.  Third 
posterior  convolution.  IV.P,  IV.P.  Fourth  posterior  convolution.  m.A.  Third  anterior  convolution,  iv. 
Fourth  anterior  convolution.  "  Suppose,"  says  Leuret,  "  that  all  the  superior  convolutions,  s  s  s  s,  and  the 
prolongation,  -{-?  of  the  internal  convolution  are  obliterated,  the  fourth  anterior  convolution  might  be  united 
to  the  fourth  posterior  convolution,  the  third  to  the  third,  and  we  should  have  one  of  the  groups  of  con- 
volutions of  the  brain  of  the  Ruminants  and  Solipedes."  Reduced  one  half. 

The  ape  has  three  anterior  convolutions  (i.  A,  n.  A,  in.  A.,  fig.  68), 
three  posterior  (i.  P,  n.  P,  in.  P,  fig.  68),  two  superior  (s  s,  s  s),  one 
internal,  and  the  supra-orbital  convolutions,  also  corresponding  to  those 
in  man  (figs.  73-4-5).  The  orbital  convolutions  always  exist;  they  are 
larger  and  better  divided  than  in  the  inferior  animals,  but  they  do  not 
show  the  same  regularity  as  the  others. 

"  The  brain  of  the  chimpanzee,"  says  Mr.  Owen,  "in  the  relative 
proportions  of  the  different  parts,  and  the  disposition  of  the  convolutions, 
especially  those  of  the  posterior  lobes,  approaches  nearest  to  the  human 
brain  ;  it  differs  chiefly  in  the  flatness  of  the  hemispheres,  in  the  com- 
parative shortness  of  the  posterior,  and  in  the  narrowness  of  the  anterior 
lobes." 

It  also  approaches  nearer  to  the  human  brain  than  that  of  the  other 
Mammalia,  in  the  absence  of  the  corpus  trapezoidum  (see  College  pre- 


124 


COMPARATIVE    ANATOMY. 


paration  1338),  which,  I  observe,  exists  in  the  brain  of  many  of  the  apes, 
though  I  cannot  affirm  that  the  chimpanzee  is  the  only  exception. 


Fig.  67. 


The  cerebral  surface  of  the  right  lobe  of  the  brain  of  the  Indian  elephant.  (Leuret.)  s  s.  Fissura  Sylvii. 
I.A,  II.A.  III.A.  Three  anterior  convolutions.  They  all  have  a  common  origin  from  the  convolutions  s  s  s, 
which  is  the  most  anterior  of  the  superior  convolutions.  Behind  the  superior  convolutions  s  s  s,  there  is 
a  fissure,  the  analogue  of  which  exists  in  man  and  the  ape,  and  which  Leuret  calls  the  fissure  of  Rolando. 
Below  this  fissure  are  seen  some  voluminous  superior  convolutions,  s'  s'  s"  s",  which,  like  the  convolu- 
tions s  s  s,  intercept  the  continuity  of  the  anterior  with  the  posterior  convolutions.  I.P,  I.P.  First  posterior 
convolution  situated  behind  the  fissura  Sylvii,  and'which  is  reunited  to  the  convolution  I.A.  if  the  superior 
convolutions  do  not  exist,  n.p,  n.p.  Second  posterior  convolution,  in. P.  Third  posterior  convolution. 
p  o.  Supra-orbital  convolution.  Leuret  states  that  he  has  taken  great  pains  to  have  the  size  of  the  draw- 
ing accurate.  The  cut  is  reduced  one-half. 

"  The  number,  form,  arrangement,  and  relations  of  the  cerebral  con- 
volutions," says  Leuret,*  "  are  not  formed  at  hazard  :  every  family  of 
animals  has  a  brain  formed  in  a  determinate  manner,  arid  the  difference 
of  opinions  on  this  subject  arise  from  the  want  of  attentive  examination 
of  a  sufficient  number  of  brains.  Observation  has  thus  shown  what  strict 
induction  had  led  us  to  conclude.  How,  indeed,  can  we  believe,  that 
the  most  important  organ  of  the  economy,  that  by  which  the  manifesta- 
tions of  intelligence  operate,  to  which  is  attributed  the  instincts  and  pas- 
sions, has  not  a  fixed  organization,  and  as  invariable  as  that  of  other 
parts.  Each  group  of  brains  has  a  type  which  is  proper  to  it,  and  this 
type  is  especially  manifested  by  the  form  of  its  convolutions." 

"  In  the  foxes  the  divisions  are  clear  and  well  marked  ;  in  the  cats 

*  Op.  cit,  p.  399. 


CONVOLUTIONS. 


125 


the  divisions  are  less,  but  still  the  forms  are  fixed  and  very  simple  ;  in 
the  bears  and  martens  there  is  a  tendency  to  another  form,  complete  pre- 
servation of  some  convolutions,  which  I  have  called  primitive,  on  ac- 
count of  their  simplicity,  and  disposition  of  some  of  the  others  to  unite 
and  present  undulations.  In  the  next  type,  the  fundamental  separations 
are  less  numerous  and  of  greater  variety  in  their  details  for  the  different 
groups  to  which  the  wombat,  kangaroo,  roebuck,  pig,  seal,  and  whale 
belong.  Next,  as  in  the  elephant,  an  entire  addition  to  the  general 
forms,  with  an  infinite  development  of  details.  In  the  ape  a  still  more 
perfect  type,  nearer  to  man,  but  incomplete  and  rudimentary." 

Fig.  08. 


Left  side  of  the  brain  of  the  baboon  (Singe  Papio).  (Leuret.)  s  s.  Fissure  of  Sylvius,  running  obliquely 
from  before  backwards,  s  K.  Fissure  of  Rolando,  sss,  s's's'.  The  two  superior  convolutions.  LA, 
it. A,  in. A.  First,  second,  and  third  anterior  convolutions,  arising  all  three  from  the  same  superior  convo- 
lution. I.P,  H.P,  III.P.  First,  second,  and  third  posterior  convolutions.  The  first,  Jong,  isolated,  and 
turned  round  above  the  fissura  Sylvii,  and  directed  towards  the  first  anterior  convolution,  from  which  it 
is  separated  by  the  lowest  part  of  the  superior  convolutions.  The  second  and  third  convolutions  are  car- 
ried above  and  behind  the  cerebellum,  and  are  in  part  confounded  one  with  the  other,  -f-  Point  of  re- 
union and  prolongation  of  the  superior  convolution,  s'  s'  s',  with  the  prolongation  of  the  internal  convo- 
lution. 2.  Lateral  lobe  of  the  cerebellum.  3.  Third  lobe  of  the  cerebellum,  orjloeons. 

"In  each  family,  as  a  general  rule,  the  more  the  brain  increases,  the 
more  it  divides,  the  more  also  it  acquires  undulations.  The  fox,  the 
domestic  cat,  the  weazel,  the  ferret,  the  roebuck,  the  peccary,  each  re- 
presents the  first  step  of  a  scale,  at  the  summit  of  which  is  the  dog,  the 
lion,  the  otter,  the  hyrax,  and  the  boar.  In  its  class  the  elephant  is  at 
the  summit  ;  but  I  know  of  no  animal  which  can  be  placed  at  the  oppo- 
site end.  In  its'  own  class  the  lemur  is  very  low,  the  ape  very  high,  and 
man  very  far  above  the  ape.  However,  there  are  some  large  brains 
which  do  not  represent  a  perfect  type  of  some  small  brains  of  the  same 
class.  Thus,  that  of  the  ox  is  not  more  perfect  than  that  of  the  sheep, 
that  of  the  whale  is  not  above  that  of  the  porpoise."  "Are  there  inter- 


126  COMPARATIVE   ANATOMY. 

mediate  degrees,"  modestly  says  Leuret,  " between  all  these  brains? 
Are  there  any  forms  of  brain  different  from  those  that  I  have  described? 
Observations  more  extended  can  alone  resolve  these  questions,  which 
are  of  the  deepest  interest  for  anatomy  and  psychology." 

Cerebral  Vessels. — In  the  Mammalia,  below  the  human  subject,  the 
brain  is  not  supplied  by  the  same  set  of  blood-vessels.  In  man,  we  find, 
the  two  internal  carotid  and  two  vertebral  arteries,  distributing  their 
branches  almost  entirely  to  the  brain  ;  but  it  is  by  no  means  invariably 
the  case  throughout  the  class  of  mammals.  Without  pretending  to  give 
a  minute  account  of  these  varieties,  I  shall  briefly  refer  to  some  of  the 


most  interesting. 


When  we  have  advanced  to  the  study  of  the  cerebral  vessels  in  man, 
•we  shall  meet  with  a  beautiful  contrivance  to  avert  the  force  of  the 
heart's  action  on  the  brain.  The  carotid  and  vertebral  arteries,  instead 
of  running  directly  in  a  straight  line  from  the  heart  into  the  skull,  are 
bent  twice  nearly  at  a  right  angle,  thus  twice  changing  a  perpendicular 
to  an  horizontal  course.  In  some  of  the  lower  animals — the  cat,  for 
instance — the  vertebral  artery  is  turned  as  in  man.  But,  in  addition 
to  this  arrangement  of  these  vessels,  we  meet  with  another  of  great  phy- 
siological interest,  and  evidently  intended  to  serve  the  same  purpose. 
This  is  formed  by  the  division  of  the  carotid  artery  within  the  skull  into 
numberless  small  vessels,  which,  meeting  again,  form  a  most  wonderful 
net-work — rete  mirabile — and  well  has  it  been  thus  named.  It  was 
first  discovered  and  described  by  Galen.  A  trunk  is  formed  by  the 
union  of  these  vessels,  which  supplies  the  brain.  We  shall  have  occa- 
sion to  consider  the  formation  of  this  rete  again,  when  we  have  turned 
our  attention  to  some  of  the  peculiarities  regarding  the  relative  size  and 
distribution  of  the  carotid  and  vertebral  arteries.  The  carotid  arteries 
are  subject  also  to  much  variety. 

Sometimes  the  common  carotid  arteries  bifurcate,  as  in  man,  into 
external*  and  internal  carotids,  the  latter  maintaining  a  large  calibre. 
Sometimes,  as  in  some  of  the  baboons,  the  common  carotid,  after  having 
given  off  the  usual  branches  of  the  external  carotid,  enters  the  cranium 
as  the  internal,  which  in  other  instances  appears  like  a  subordinate 
branch  of  the  external  carotid.  In  the  common  porpoise,  the  large  size 
of  w?hose  brain  we  have  already  observed,  the  carotid  divides  nearly  as 
in  man,  with  merely  the  exception  that  it  gives  off  the  superior  thyroid 
and  a  cervical  branch  first. 

In  the  tiger,  the  internal  carotid  is  not  given  off  until  the  common 
carotid  has  distributed  the  usual  branches  of  the  external.* 

The  internal  carotid  does  not  give  off  the  ophthalmic  artery  in  the 
Carnivora,  Rodentia,  Rurainantia,  or  Pachydermata.  This  vessel  ascends 
into  the  orbit  through  the  foramen  lacerum  orbitare  inferius,  which  is 
very  large. 

In  those  ruminants  in  whom  the  rete  mirabile  exists,  a  true  internal 
carotid  can  scarcely  be  said  to  be  present,  but  its  place  is  supplied  by 
two  vessels  on  each  side,  one  of  which  enters  the  skull  by  a  foramen 
which  corresponds  to  the  foramen  rotund u in  and  foramen  orbitare  supe- 

*  Cuvier,  Lemons,  ed.  1839,  t.  vi. 


CEREBRAL   VESSELS.  127 

rius,  the  other  through  the  foramen  ovale.  In  the  pig,  the  largest  of  the 
two  vessels  passes  through  the  foramen  lacerum  basis  cranii,  and  a 
smaller  one  through  an  interior  portion  of  the  same  foramen.  The  caro- 
tid canal  is  absent  in  all  cases  where  the  plexus  is  present;  but  its 
absence  does  not  necessarily  indicate  the  presence  of  a  plexus. 

The  vertebral  artery  is  subject  to  much  variety  both  in  regard  to  its 
origin,  distribution  and  size;  in  some  animals,  as  the  hedgehog,  it  arises 
from  the  common  carotid. 

In  this  animal,  and  in  the  hybernating  Rodentia,  it  is  much  larger 
than  the  carotid ;  also  in  some  other  of  the  Rodentia,  as  the  rabbit.  In 
these  cases,  the  basilar  artery  forms  nearly  the  whole  of  the  circle  of 
Willis,  furnishing  the  anterior  as  well  as  the  posterior  arteries  of  the 
brain.*  This  fact  is  important  in  reference  to  experiments  made  with 
ligatures  on  the  internal  carotids,  and  the  deductions  from  them  in  rela- 
tion to  the  physiology  of  the  brain. 

Professor  Rapp,  of  Tubingen, f  states,  that  "  the  vertebral  arteries  do 
not  reach  the  brain  in  all  those  animals  that  possess  a  rete  mirabile." 
In  Ruminants,  the  vertebral  arteries  usually  enter  the  spinal  canal,  be- 
tween the  second  and  third  cervical  vertebrae,  without  piercing  the  dura 
mater  of  the  cord :  they  then  join,  but  separate  again  almost  immediately  : 
in  the  calf  and  goat,  these  arteries  are  connected  by  transverse  branches ; 
this  union  seems  to  indicate  a  basilar  artery,  although  it  does  not  take 
place  in  the  skull,  nor  internal  to  the  dura  mater.  Each  artery,  after 
having  given  off  twigs  to  the  various  muscles,  joins  on  the  atlas  the 
condyloid  artery,  a  branch  of  the  external  carotid,  which  comes  through 
the  condyloid  foramen  into  the  skull;  then,  without  piercing  the  dura 
mater,  turns  backwards,  receives  the  vertebral  arteries,  then  passes 
through  a  foramen  in  the  atlas,  anastomoses  with  a  branch  of  the  exter- 
nal carotid,  and  is  distributed  to  the  muscles  at  the  back  of  the  neck. 
This  union  of  the  vertebral  arteries,  with  a  twig  of  the  external  carotid, 
is  remarkable,  and  explains  why,  in  an  animal  in  whom  no  blood  is  car- 
ried to  the  brain  by  the  vertebral  arteries,  both  common  carotids  may 
be  tied  without  causing  the  death  of  the  animal.  This  operation  has 
been  performed  by  Parry  on  sheep." 

In  the  stags  and  chamois  there  is  a  considerable  anastomosis  between 
the  rete  mirabile,  the  condyloid  artery,  and  a  vessel  in  which  the  anterior 
spinal  artery  terminates ;  the  anastomosing  branch  passing  through  the 
jugular  foramen  into  the  skull. 

In  the  calf,  also,  there  is  an  anastomosis  between  branches  of  the 
vertebral  artery  and  rete  mirabile  (see  fig.  69,  E). 

The  rete  mirabile  may  be  exposed  in  the  skull  of  the  sheep  and  calf, 
which  are  convenient  for  the  purpose,  by  raising  the  dura  mater  on  each 
side  of  the  sella  turcica,  and  then  opening  the  cavernous  sinus.  If  the 
vessels  are  filled  with  red  wax,  they  present  the  beautiful  appearance 
represented  in  fig.  69.  This  plexus  is  surrounded  by  the  venous  blood 
of  the  sinus,  the  sixth  pair  of  nerves  running  through  it.  The  vessels  of 
the  rete  anastomose  freely:  in  the  swine,  beneath  the  pituitary  gland  ; 
posterior  to  it  in  the  goat,  stag,  sheep,  and  roe. 

*  Cuvier,  ed.  1839,  vol.  vi.  p.  118.  t  Meckel's  Archives  for  1827,  p.  5. 


128 


COMPARATIVE    ANATOMY. 


This  rete  mirabile  has  a  different  appearance  in  different  animals,  so 
that  when  separated  from  the  skull  it  cannot  be  recognized  as  coming 
from  any  particular  animal.  In  the  calf  the  vessels  forming  the  plexus 
are  comparatively  thick,  and  make  numerous  abrupt  curves.  In  the  goat 
and  chamois  they  are  in  this  respect  most  like  the  calf;  in  all  these  the 
net  is  very  close.  In  the  stag  it  is  more  open.  In  the  sheep  the  vessels 
are  thin,  and  very  numerous  and  straight.  We  have  a  good  preparation 
of  it,  from  this  animal,  in  the  Museum  of  St.  Thomas's  Hospital,  made 
by  Sir  Astley  Cooper.  In  the  fetus  it  is  comparatively  larger  than  in  the 
full-grown  animal,  corresponding  with  the  size  of  the  brain. 

Fig.  69. 


,-;:, 

Rete  mirabile  of  the  calf.  (Rapp.)  The  cavity  of  the  skull  and  the  spinal  canal  are  opened ;  the  brain, 
spinal  cord,  and  dura  mater  have  been  removed.  A.  The  cerebral  carotid  arteries  arising  from  the  rete 
mirabile.  B.  The  vertebral  arteries  in  the  spinal  canal,  c  c.  The  vertebral  arteries  passing  through  the 
foramen  in  the  atlas.  D.  Branches  of  the  vertebral  arteries  passing  forwards  under  the  dura  mater  to 
anastomose  with  the  arteria  condyloidea,  forming  thus  u  plexus  which  is  connected  to  the  rete  mirabile. 
E.  Arteria  condyloidea. 

Professor  Rapp  found  the  vessels  slightly  atrophied  in  cases  of  partial 
destruction  of  the  brain  by  the  coenurus  cerebralis.  The  cerebral  carotid 
is  formed  by  a  union  of  all  the  twigs  of  this  plexus.  The  artery  always 
penetrates  the  dura  mater  on  the  side  of  the  pituitary  gland,  and  then 
forms  the  circle  of  Willis,  and  gives  off  branches  perfectly  similar  to 
those  in  man.  From  the  posterior  portion  of  the  circle  arises  a  vessel, 
which  has  erroneously  been  called  the  basilary,  but  is  really  the  anterior 
artery  of  the  spinal  cord. 


CEREBRAL   VESSELS.  129 

Rapp  found  this  plexus  in  the  stag,  roe,  the  fallow-deer,  chamois,  the 
goat,  sheep,  and  calf,  and  oxen.  He  considers  that  the  arrangement  of 
the  foramina  in  the  base  of  the  skull  in  the  camel  indicates  its  existence 
in  this  animal,  but  he  has  not  had  the  opportunity  of  seeing  the  parts  in 
a  recent  state.  It  exists  also  in  swine,  but  it  does  not  occur  in  other 
Mammalia  besides  the  Ruminantia  and  swine.  Cuvier's  statement  cer- 
tainly differs  from  this:  he  says  that  this  vascular  arrangement  appears 
to  occur  in  most  of  the  Carnivora,  but  is  absent  in  the  elephant  and 
beaver.  According  to  Carus  it  is  present  in  most  Mammalia,  and  Willis 
says  it  exists  in  the  dog,  the  fox,  cat,  &c. ;  but  this  is  a  mistake,  for  it 
does  not  occur  in  the  dog,  fox,  badger,  weazel,  otter,  or  hedgehog,  or  in 
the  domestic  cat.  But  it  has  been  found  by  Mr.  Quekett  in  the  leopard. 
Neither  is  it  found  in  man,  the  apes,  horse,  elephant,  or  the  Rodentia. 
In  the  domestic  cat  there  is  an  arterial  plexus  beneath  the  orbit,  anterior 
to  the  articulation  of  the  lower  jaw,  which  sends  anastomoses  through  the 
supra-orbitar  fissure  to  the  carotis  cerebralis  in  the  cranium,  which  is 
thus  enlarged  immediately  after  entering  the  skull  at  the  anterior  and 
internal  extremity  of  the  petrous  bone.  Rapp  found  a  similar  rete  mira- 
bile  of  the  ophthalmic  in  all  Ruminants,  but  not  in  swine;  this  ophthalmic 
rete  mirabile  is  formed  out  of  the  arteria  ophthalmica,  a  branch  of  the 
external  carotid :  it  lies  between  the  musculus  suspensorius  and  the  rectus 
superior;  out  of  this  net  arise  the  ciliary  arteries;  it  is  peculiarly  beauti- 
ful in  the  sheep,  and  smaller  in  the  goat.  In  the  horse  the  carotids  do 
not  enter  through  a  carotid  canal,  but  through  a  foramen  lacerum,  and 
are  then  united  by  a  thick  transverse  branch  before  penetrating  the  dura 
mater. 

Harwood  suggested  that'the  office  of  this  plexus  was  to  moderate  the 
pressure  of  the  blood  against  the  brain  in  those  animals  in  whom  the 
position  of  the  head  was  constantly  depending.  But  Rapp  does  not  agree 
with  him,  though  he  allows  that  it  will  moderate  pressure;  but  that  it 
has  no  relation  to  position. 

In  the  horse  this  result  is  obtained  by  the  strong  bendings  of  the 
cerebral  carotid  and  by  the  vertebral  arteries  which  also  supply  the  brain. 

It  was  supposed  to  be  absent  in  the  giraffe,  and  this,  in  connection 
with  the  mode  in  which  this  animal  obtains  its  food  from  the  branches 
of  trees,  instead  of  stooping  to  crop  it  from  the  ground,  was  considered 
an  additional  argument  in  favor  of  Harwood's  opinion.  Mr.  Quekett, 
of  the  College  of  Surgeons,  has,  however,  succeeded  in  injecting  and 
clearly  demonstrating  its  existence. 


130 


PART  III. 

PKOTECTIVE  APPARATUS  OF  THE  HUMAN  BEAIN. 

FROM"  what  has  been  already  said  regarding  the  important  office  of  the 
cerebro-spinal  axis,  our  reader  will  be  prepared  to  find  in  man  some 
special  and  beautiful  provision  for  its  protection. 

The  materials  which  form  the  protective  apparatus  may  be  classed 
under  three  heads:  1.  The  osseous  or  bony.  2.  The  membranous. 
3.  The  aqueous  or  fluid.  The  bony  apparatus  of  protection  in  the  lower 
animals,  as,  for  instance,  in  many  insects,  in  the  lobster  and  crab  tribes, 
&c.,  is  formed  by  a  simple  hardening  of  the  general  covering  or  integu- 
ment of  the  body  ;  and  the  skeleton  which  is  thus  formed  is  called  a 
dermal  or  skin  skeleton.  The  inconvenience  of  such  an  arrangement 
must  be  evident,  when  we  consider  that  this  skeleton  must  be  cast  off 
periodically  in  order  to  allow  the  animal  to  increase  in  size.  The  lob- 
ster throws  off  its  shell,  and  draws  its  limbs  out  of  their  calcareous  cover- 
ings, as  we  do  our  legs  out  of  our  boots.  But  during  the  period  while 
the  new  skeleton  is  growing,  the  animal  is  left  in  a  miserably  weak  and 
helpless  condition,  an  easy  prey  to  its  enemies. 

In  the  higher  animals  the  skeleton  is  as  much  a  part  of  the  living  crea- 
ture as  the  soft  skin,  muscles,  or  other  living  tissues,  and  is  placed 
within  the  body,  increasing  as  the  organs  which  it  protects  increase  in 
size. 

The  osseous  framework  which  in  man  appears  so  complicated,  and 
performs,  with  its  connecting  ligaments  and  attendant  muscles,  so  many 
and  such  various  offices,  as  prehension,  mastication,  locomotion,  &c., 
in  the  simple  form  in  which  it  first  appears  in  the  animal  kingdom,  is 
first  a  tube  of  cartilage,  or  a  jointed  column  inclosing  the  spinal  cord, 
•without  appendages  or  limbs  for  other  functions.  This  is  called  the  ver- 
tebral column.  Its  presence  in  the  animal  kingdom  is  so  clear  a  mark 
of  a  comparatively  high  development  of  the  nervous  system,  that  physi- 
ologists, as  we  have  already  seen,  divide  animals  into  two  great  groups, 
the  Invertebrata,  or  creatures  without  vertebrae  ;  and  the  Vertebrata,  or 
animals  possessing  a  vertebral  column.  It  would  not  be  consistent  with 
the  plan  of  this  work  to  enter  into  a  description  of  the  mechanism  of  the 
vertebral  column  in  the  different  classes  of  animals.  If  we  once  entered 
on  this  subject,  the  abundance  of  matter,  and  the  interest  attaching  to  it, 
would  render  it  very  difficult  to  us  to  abandon  it.  We  shall,  therefore, 
merely  remark  that  the  cerebro-spinal  axis  in  man  is  situated  in  a  long 
bony  canal,  which  is  expanded  superiorly  into  a  cavity  of  considerable 
size.  The  difference  in  the  dimensions  of  the  two  portions  of  this  canal 


MEMBRANES,    ETC.  131 

has  led  anatomists  to  divide  it  in  their  descriptions,  the  upper  portion 
being  called  the  skull  or  cranium,  the  lower  the  vertebral  or  spinal  canal. 
Now,  though  in  man  this  division  seems  even  natural,  the  two  portions 
differing  so  entirely  in  size  and  general  appearance,  still  if  we  observe 
the  same  parts  in  the  lower  orders  of  animals,  and  trace  their  alterations 
of  form  and  capacity  as  the  organs  which  they  contain  increase  in  size, 
and  require  a  change  in  the  shape  and  extent  of  the  cavity  which  con- 
tains them,  we  shall  find  that  the  bones  composing  the  human  skull  are 
simply  vertebraB  in  a  more  expanded  form,  and  exhibit  those  alterations 
in  shape  which  adapt  them  to  the  increased  size  of  the  organ  they  are 
formed  to  protect.* 

The  student,  in  considering  the  relation  of  this  osseous  envelop  to 
the  brain,  must  bear  in  mind  its  vital  properties — that  the  skull,  which 
so  beautifully  protects  this  delicate  organ  by  its  physical  hardness,  is 
modeled  in  its  form  and  shape  by  a  soft  substance  like  the  brain.  The 
facts  which  have  been  accumulated  of  late  years,  showing  that  the  form 
of  the  skull  alters  at  different  periods  of  life,  are  extremely  interesting 
and  important.  As  illustrating  the  physiology  of  the  brain,  they  will  be 
referred  to  hereafter.  If  the  brain  were  not  protected  by  an  internal 
skeleton,  this,  of  course,  could  not  take  place;  and,  even  in  the  present 
day,  it  is  not  uncommon  to  hear  the  opponents  of  phrenology  ridicule 
the  idea  of  the  soft  brain  producing  any  impression  on  the  hard  skull. 

As  the  following  description  of  the  anatomy  of  the  cerebro-spinal 
mass  in  the  human  being  is  intended  to  assist  those  who  are  commencing 
their  studies,  the  best  mode  of  opening  the  skull  and  vertebral  canal  so 
as  to  reach  without  injury,  and  to  expose  the  structure  of,  the  nervous 
masses  contained  within  them,  shall  next  be  explained. 

The  student  should  place  the  subject  on  its  face,  and,  raising  the 
head,  rest  the  chin  upon  a  block,  so  as  to  fix  it  in  a  horizontal  position. 

An  incision  must  then  be  made  through  the  scalp,  extending  across 
the  vertex  from  ear  to  ear.  The  anterior  part  of  the  scalp  may  then  be 
forcibly  torn,  instead  of  being  dissected,  from  the  skull  over  the  face, 
and  the  posterior  over  the  occiput,  which  will  save  much  time;  but 
some  force  is  required  to  effect  this  reflection  of  the  integuments. 

A  deep  groove  must  be  made  with  the  saw  through  the  outer  table 
and  diploe,  commencing  half  an  inch  above  the  superciliary  ridges  an- 

*  This  opinion,  that  the  cranium  is  formed  by  a  series  of  vertebrae,  originated  with  Peter 
Frank  (see  Edinb.  Med.  Surgical  Journal,  vol.  xliii.  p.  288),  (Epit.  de  Curand.  Horn.  Morb., 
lib.  ii.  p.  42),  and  Burdin  (Cours  il'Etudes  Medicales,  Paris,  1803,  tome  i.  p.  16);  and  was 
afterwards  espoused  by  Kielmeyer  (Ulrich,  Annotationes  quaedam  de  Sensu  ac  Significa- 
tione  Ossiurn  Capitis,  Berlin,  1816,  p.  4),  Dumeril  (Magazine  Encyclopedique,  tome  in 
1S08),  and  Goethe  (Zur  Naturvvissenschaft,  Band  i.  p.  250),  and  more  or  less  fully  illus- 
trated by  Oken  (Ueber  die  Bedeutung  der  Schadelknocken,  Jena,  1807  ;  Isis,  1820,  No.  VI. 
p.  552),  Spix  (Cephalogenesis,  Munich,  1815),  De  Blainville  (Bulletin  de  la  Soc.  Philorn., 
1816,  p.  Ill,  and  1817),  Geoffroy  St.  Hilaire  (Philosophic  Anatomique,  Paris,  1818-22), 
Carus  (Lehrbuch  der  Zootomie,  Leipzig,  1818,  p.  164),  Meckel  (Beytrage  zur  Vergleichen- 
den  Anatomic,  Band  ii.  Stuck  ii.),  Schultz  (De  Primordiis  Systematis  Ossium,  &c.,  Halle, 
1818,  p.  13),  Bojanus  (Isis,  1818,  p.  301;  1819,  p.  1364),  and  Burdach  (Vierter  Bericht  von 
der  Anatomischen  Anstalt  zu  Koenigsberg,  Leipzig,  1821).  Arnold  also  adopts  this  princi- 
ple, but  confines  himself  to  the  views  given  by  Oken,  Cuvier,  Carus,  Spix,  and  Meckel,  con- 
sidering that  the  cranium  consists  of  three  vertebrae  only;  not,  therefore,  agreeing  with 
Geoffroy  St.  Hilaire,  who  believes  that  he  can  there  demonstrate  the  parts  of  nine  vertebras. 


132  HUMAN    BRAIN. 

teriorly,  and  extending  round  the  entire  skull  to  the  protuberance  of  the 
os  occipitis  posteriorly. 

A  small  axe  should  next  be  used  to  break  the  inner  table,  which  is 
much  better  than  sawing  it  entirely  through,  as  being  less  likely  to  injure 
the  dura  mater  and  brain,  and  as  permitting  the  skull  to  be  more  firmly 
fixed  again  when  replaced  after  the  dissection  is  completed. 

The  skull-cap  being  removed,  a  dense  fibrous  membrane  is  perceived 
beneath  it,  rough  on  its  surface  owing  to  the  torn  extremities  of  the 
vessels  which  connected  it  to  the  internal  table  of  the  skull;  for  this 
membrane,  which  is  the  internal  periosteum  of  the  cranial  bones,  and  in 
the  young  subject  connected  at  the  edges  of  the  several  bones  with  the 
external  periosteum,  adheres  to  the  bones  so  closely  that  they  are  with 
difficulty  separated.  The  glistening  membrane  thus  exposed  is  called 
the  dura  maler^  from  the  density  and  firmness  of  its  texture,  and  from  an 
idea  that  it  was  the  origin  or  mother  of  all  the  other  fibrous  membranes 
of  the  body.* 

On  the  surface  of  this  membrane  are  some  small  rounded  bodies, 
which  certainly  were  undeserving  of  notice  if  they  had  not  received  the 
grand  title  of  glandule  PacchioniA  These  are  scarcely  observable  in 
the  young  subject,  and  in  the  old  are  most  probably  a  morbid  appear- 
ance. The  dura  mater  should  next  be  cut  through  carefully  all  round 
with  a  pair  of  scissors,  on  a  level  with  the  divided  edge  of  the  skull. 
On  being  turned  back  over  the  upper  part  of  the  brain,  we  discover  that 
its  under  surface  is  smooth  and  polished  ;  a  circumstance  which  does 
not  arise  from  any  peculiarity  in  the  texture  of  its  internal  surface  as 
opposed  to  the  external,  but  from  the  presence  of  a  serous  membrane, 
called  the  tunica  arachnoidea,  which,  like  all  serous  membranes,  is  a 
thin  diaphanous  web,  covering  the  contained  viscus,  and  reflected  from 
thence  on  to  the  internal  surface  of  the  walls  of  the  containing  cavity- 
The  next  membrane,  therefore,  which  we  observe  covering  the  brain 
when  the  dura  mater  is  raised,  is  that  portion  of  the  arachnoid^  which, 
from  its  investing  the  brain,  may  be  called  the  tunica  arachnoidea  cere- 
bralis  or  investiens,  in  contradistinction  to  that  portion  which  lines  the 

*  Portal  iv.  2.  The  membranes  of  the  brain,  by  the  Greeks,  were  called  meninges,  the 
Greek  word  fjtnwy%  simply  signifying  a  membrane.  The  term  mater,  or  mother,  originated 
with  the  Arabs,  and  the  credit  of  having  shown  that  the  dura  mater  does  not  accompany  the 
nerves  in  their  passage  from  the  skull,  and  that  the  membranes  in  general  are  therefore  not 
continuous  with  it,  is  due  to  Ludwig. 

f  So  called  after  Pacchionus,  who  first  described  them  as  glandular  structures  destined  to 
secrete  a  peculiar  lymph :  he  even  went  so  far  as  to  state  that  their,  secretory  ducts  terminate 
in  the  longitudinal  sinus.  Cruveilhier  (Anat.  Descript.,  tome  iv.)  acknowledges  our  igno- 
rance of  their  nature,  but  scarcely  regards  them  as  a  morbid  production :  their  seat  is  in  the 
subarachnoid  cellular  tissue. 

Wengel,  (De  penitiori  structura  cerebri  hominis  et  brutorum,)  p.  17,  1812,  says,  after  de- 
tailing the  opinion  of  Malacarne  in  support  of  that  of  Pacchionus,  "  Eorum  ortus  absque 
dubio  a  morboso  statu,  inconstans  incertus,  ex  octate  aliisque  fortuito  accidentibus  cireum- 
stantiis  est."  En.  Anat.,  vol.  iii.  345. 

Dr.  Todd  considers  them  as  morbid  products.  "  That  they  are,"  says  this  writer,  "  the 
product  of  a  chronic,  very  gradual  irritation,  due  to  more  or  less  frequent  functional  excite- 
ment of  the  brain  itself." — "  They  are  peculiar  to  the  human  subject.  Nothing  similar  to 
them  has  been  found  in  any  of  the  inferior  classes  of  animals." 

J  Portal,  iv.  2.  The  arachnoid  derives  its  name  from  its  extreme  delicacy  and  its  resem- 
blance to  a  cobweb ;  it  was  first  described  as  a  special  membrane  in  1 565,  by  the  Dutch 
Society,  among  the  members  of  which  was  Swammerdam,  the  celebrated  naturalist. 


PROCESSES   OF   THE   DURA   MATER.  133 

dura  mater  and  is  called  the  tunica  arachnoidea  reflexa.  The  further 
description  of  this  membrane  will  be  postponed  until  we  have  completed 
that  of  the  dura  mater.  The  dura  mater  forms  several  processes  in  the 
interior  of  the  skull,  some  of  which  are  best  seen  after  the  removal  of 
the  brain  as  directed  further  on,  but  which  it  will  be  in  order  to  describe 
at  once. 

The  dura  mater  consists  of  two  layers  united  by  cellular  tissue,  the 
external  of  which  forms,  as  described,  the  internal  periosteum  of  the 
bones  of  the  skull.  The  separation  between  these  two  portions  is  per- 
fect in  the  vertebral  canal,  though  at  the  internal  surface  of  the  atlas,  the 
spinal  dura  mater  and  periosteum  of  the  vertebral  canal  meet  together, 
and  adhere  so  as  to  exhibit  in  the  skull  the  appearance  of  one  membrane. 
Dr.  Knox,  in  the  Lancet  of  the  19th  October,  1839,  remarks,  that  in 
some  animals  the  vascularity  of  the  external  layer  is  very  striking,  as  in 
certain  Cetacea — the  Rorqual,  for  example — where  there  is  a  perfectly 
distinct  vascular  layer  between  the  dura  mater,  properly  so  called,  and 
the  Calvarium.  This  is  not  surprising,  when  we  consider  the  vast 
thickness  of  the  bones  of  the  skull  in  these  creatures. 

Processes  of  the  Dura  Mater. — The  internal  layer  is  inflected  down- 
wards between  the  two  symmetrical  halves  of  the  brain,  forming  what 
has  been  called,  from  its  sickle-like  appearance,  the  falx  major  of  the 
dura  mater  (FM,  figs.  70  and  71).  This  structure  may  be  said  to  com- 
mence from  the  crista  galli  of  the  ethmoid  bone,  where  it  is,  generally, 
about  half  an  inch  in  width,  though  it  varies  in  different  subjects  ;  from 
this  point  it  extends  backwards,  gradually  becoming  wider  in  its  pas- 
sage, and  being  connected  through  the  medium  of  the  periosteal  portion 
to  the  frontal,  parietal,  and  occipital  bones.  On  reaching-the  transverse 
ridge  of  the  occipital  it  splits  into  two  lateral  portions,  which  are  at- 
tached posteriorly  and  laterally  to  the  transverse  ridge  of  the  occipital 
bone,  while  anteriorly  it  is  attached  to  the  superior  angles  of  the  petrous 
portions  of  the  temporal  bone,  from  which  points  it  stretches  itself  up  to 
the  posterior  clinoid  processes  of  the  sphenoid,  leaving  a  space  between 
its  under  surface,  and  that  portion  which  covers  the  superior  angles  of 
the  temporal  bone,  through  which  passes  the  fifth  pair  of  nerves. 

This  portion  of  the  dura  mater  is  called  the  tentorium  (T,  fig.  70),  and 
forms  an  extended  surface  on  which  the  posterior  lobes  of  the  hemi- 
spheres rest;  and  by  which  the  cerebellum,  which  is  situated  beneath,  is 
protected  from  the  superincumbent  pressure  of  the  brain  (fig.  71):  con- 
sequently, the  tentorium  so  far  resembles  in  its  office  the  falx  major, 
which  prevents  one  hemisphere  from  pressing  on  the  other  when  the 
head  is  inclined  to  either  side. 

Extending  down  along  the  mesial  line  of  the  occipital  bone  beneath 
the  tentorium,  there  is  another  process  analogous  to,  but  much  smaller 
than,  the  falx  major;  it  separates  the  two  lobes  of  the  cerebellum,  and 
has  received  the  name  of  the  falx  minor ;  it  commences  on  the  internal 
surface  of  the  occipital  bone,  at  the  point  where  the  transverse  and 
longitudinal  ridges  meet,  and  extends  to  the  edge  of  the  foramen  mag- 
num. 

The  veins,  which  return  the  blood  from  the  substance  of  the  brain, 
are  protected  from  the  pressure  of  that  organ,  by  the  stretching  of  the 


134  HUMAN  BRAIN, 

« 

dura  mater  over  deep  grooves  in  the  bone,  and  by  the  mechanism  of 
the  falciform  processes  and  tentorium  of  the  dura  mater,  through  the 
internal  lamina  of  which  they  pass  immediately  after  quitting  the  pia 
mater ;  the  spaces  formed  for  their  reception  by  this  peculiar  arrange- 
ment of  the  dura  mater  are  called  sinuses,  and  require  the  attention  of 
the  student.  There  are  fifteen  sinuses  in  all. 

Fig.  70. 


Vertical  section  of  the  human  head,  and  cervical  portion  of  the  spinal  column.  (Breschet.)    This  draw- 
ing shows  almost  all  the  various  sinuses  of  the  brain,  the  falx  major,  and  the  tentorium  of  the  dura  mater. 

I.  Superior  longitudinal  sinus.    2.  Inferior  ditto.   3.  Straight  sinus.    4.  Lateral  ditto.    5.  Inferior  petrosal 
sinus.    6.  Superior  ditto.    7.  Circular  sinus.    8.  Venous  plexus  at  the  commencement  of  the  spinal  canal 
upon  the  anterior  surface  of  the  posterior  arch  of  the  atlas.    This  plexus  communicates  externally  with 
the  external  vertebral  veins,  and  with  the  venous  plexuses  which  these  vessels  form  on  the  transverse 
processes,  and  below  with  the  large  spinal  veins  or  anterior  longitudinal  vertebral  sinuses;  before  witli 
the  transverse  sinuses  on  the  basiiary  process  of  the  occipital  bone;  posteriorly  with  the  posterior  occi- 
pital sinuses;  lastly,  they  terminate  in  the  lateral  sinuses,  close  to  the  jugular  foramen.    9.  Communica- 
tion of  this  plexus  with  the  jugular  vein  through  the  anterior  condyloid  foramen.     10.  Torcular  Herophili. 

II.  Vena  magna  Galeni.    12.  Anterior  longitudinal  sinus  of  the  vertebral  canal.    13.  Pterygoid  venous 
plexus.    F  M.  Falx  major.    T.  Tentorium. 

The  superior  longitudinal  (1,  fig.  70),  which  is  the  largest,  com- 
mences at  the  foramen  caecum  of  the  frontal  bone,  and,  passing  back 
along  the  upper  edge  of  the  falx  major,  reaches  the  transverse  ridge  of 
the  os  occipitis,  where  it  usually  enters  the  right  lateral  sinus.  Its  shape 
is  triangular,  and  the  openings  of  the  veins,  which  enter  contrary  to  the 
course  of  the  blood  within  it,  may  be  distinctly  seen  on  the  interior. 
Surrounding  these  openings  are  small  fibrous  cords  (the  cordce.  Willisii}^ 
adapted  to  keep  the  openings  permanently  free  for  the  regular  passage 
of  the  venous  blood,  any  obstruction  to  the  normal  circulation  of  which 
endangers  the  life  of  the  individual,  by  producing  congestion  of  the 
brain.  Running  parallel  with  the  superior  longitudinal  sinus,  but  along 
the  inferior  edge  of  the  falx,  we  find  a  much  smaller  sinus,  called  the 


SINUSES. 

inferior  longitudinal  (2,  fig.  70).  This  also  terminates  generally  in  the 
left  lateral  sinus  (4,  fig.  70) ;  previously,  however,  to  its  reaching  this 
sinus,  and  when  it  is  passing  between  the  two  layers  of  the  tentorium, 
it  receives  the  name  of  the  straight  sinus  (3,  fig.  70). 

The  course  and  extent  of  the  lateral  sinuses  are  distinctly  marked  in 
the  dry  skull;  for  they  groove  the  transverse  ridge  of  the  occipital  bone, 
and  then  crossing  the  posterior  inferior  angle  of  the  parietal,  reach  the 
internal  surface  of  the  mastoid  portion  of  the  temporal  bones,  in  which 
they  are  deeply  imbedded,  and  thus  effectually  protected  from  the  pres- 
sure of  the  cerebellum ;  they  again  cross  a  small  portion  of  the  occipital 
bone,  and  finally  terminate  at  the  foramina  jugularia,  beyond  which  they 
form  the  internal  jugular  veins:  these  sinuses  have  frequently  another 
outlet  for  their  contents,  by  means  of  the  foramen  maStoideum,  and  the 
vein  which  commences  at  this  opening  usually  joins  some  of  the  deep- 
seated  veins  of  the  neck. 

On  each  side  of  the  sella  turcica  a  considerable  space  is  left  between 
the  dura  mater  and  the  bone,  called  the  cavernous  sinus;  this  cavity  is 
not,  however,  constructed  solely  for  the  protection  of  the  venous  circula- 
tion. It  contains  the  carotid  artery,  and  guards,  from  the  pressure  of 
the  brain,  some  of  the  cerebral  nerves,  in  their  passage  to  the  orbit. 
The  nerves,  which  are  thus  protected,  are  the  third,  fourth,  first  division 
of  the  fifth,  and  the  sixth  pairs. 

The  blood  of  the  cavernous  sinus,  separated  from  the  nerves  by  the 
lining  membrane  which  is  common  to  the  whole  venous  system,  flows 
into  a  sinus,  called  the  inferior  petrosal  (5,  fig.  70),  a  name  derived  from 
its  proximity  to  the  petrous  portion  of  the  temporal  bone.  The  inferior 
petrosal  sinus  takes  its  course  along  the  edge  of  the  basilary  process  of 
the  os  occipitis,  and  terminates  in  the  internal  jugular  vein.  This  sinus 
is  connected  with  its  fellow  by  a  short  sinus,  the  transverse.  The  supe- 
rior petrosal  sinus  (6,  fig.  70)  deeply  grooves  the  posterior  edge  of  the 
superior  angle  of  the  temporal  bone,  and  terminates  in  the  lateral  sinus. 

Surrounding  the  pituitary  gland  in  the  sella  turcica  there  is  a  circular 
sinus  communicating  with  the  cavernous  sinus,  called  the  circular  sinus 
of  Ridley  (7,  fig.  70). 

The  occipital  sinuses,  the  last  we  have  to  mention,  are  situated  on 
each  side  of  the  foramen  magnum,  and  terminate  at  the  point  where  the 
straight  sinus  and  lateral  sinus  become  conjoined  ;  the  triangular  space 
left  just  before  their  junction  is  called  the  torcular  Herophili(10,  fig.  70). 

Arteries. — These  are  derived  from  numerous  sources  ;  anteriorly  there 
is  a  small  branch  from  the  ethmoidal,  and  another  larger  branch  from 
the  ophthalmic,  just  as  it  enters  the  orbit.  In  the  centre  of  the  skull 
there  are  also  two  branches,  the  smallest  coming  through  the  foramen 
lacerum  medium,  and  derived  from  the  ascending  pharyngeal  artery. 
The  larger  branch,  which  is  the  principal  artery  of  the  dura  mater,  called 
the  middle  meningeal,  is  given  off  by  the  internal  maxillary,  and  pene- 
trates the  skull  at  the  foramen  spinosum  of  the  sphenoid  bone :  this 
winds  through  a  deep  groove  in  the  sphenoid  and  parietal  bones  up  to 
the  top  of  the  skull.  The  posterior  division  derives  its  supply  from  the 
vertebral  occipital  and  posterior  aural  arteries. 

Nerves  of  the  Dura  Mater. — Cruveilhier  (tome  iv.  p.  539),  Haller, 


136  HUMAN   BRAIN. 

Wrisberg,  and  Lobstein,  denied  the  existence  of  any  nerves  to  the  dura 
mater,  while  Vieussens,  Winslow,  Lieutaud,  Portal,  Valsalva,  and  others, 
say  that  they  observed  some,  but  without  giving  a  very  satisfactory  de- 
scription. Cruveilhier  states  he  recognized  on  each  side  of  the  mesial 
line  two  nervous  filaments,  extending  from  the  fifth  pair  up  to  the  vici- 
nity of  the  superior  longitudinal  sinus  ;  a  third  nervous  filament  occupy- 
ing the  thickness  of  the  tentorium  cerebelli,  but  whose  origin  could  not 
be  demonstrated. 

Arnold  has  also  described  and  delineated,  and  Pappenhein  (Valentin, 
Repertorium,  vol.  v.  p.  87)  states,  that  this  membrane  is  supplied  by 
branches  from  the  fourth  pair,  the  frontal  branch  of  the  ophthalmic,  the 
superior  maxillary  division  of  the  fifth,  and  the  Vidian. 

The  arachnoid'membrane  lines  the  dura  mater,  and  covers  the  convo- 
luted surface  of  the  brain  without  dipping  between  the  convolutions.  It 
also  covers  the  figurate  surface*  at  the  point  where  these  two  portions 
are  continuous,  as  at  the  foramen  of  Bichat,  as  it  is  called,  after  the 
justly-celebrated  man  who  first  described  it.  The  situation'of  this  open- 
ing is  between  the  anterior  and  superior  portion  of  the  cerebellum,  and 
the  under  and  posterior  part  of  the  cerebrum,  as  will  be  better  under- 
stood when  these  parts  have  been  described  and  the  relations  of  the 
arachnoid  explained. 

F.  Arnold,  ima  paper  translated  by  R.  Knox,  with  commentaries,  loc. 
cit.,  after  quoting  various  opinions  on  this  subject,  says — "  I  entirely 
assent  to  the  accuracy  of  Bichat's  description,  and  think  that  the  arach- 
noid proceeds  to  join  the  epithelium  of  the  ventricles,  as  the  amnion  is 
in  distinct  continuation  with  the  epidermis  of  the  foetus.  In  the  dog, 
sheep,  pig,  calf,  I  have  always  found  the  foramen  of  Bichat  to  be  a 
rounded  opening,  as  described  by  him,  and  in  which  lies  the  vena 
magna  of  Galen.  Burdach's  idea  is  readily  refuted  by  an  appeal  to  the 
universal  arrangement  of  serous  membranes.  But  I  cannot  venture  to 
affirm  with  Bichat  that  the  investing  membrane  of  the  ventricles  is  a 
serous  membrane.  It  seems  to  hold  the  same  relation  to  the  substance 
of  the  brain  as  the  epidermis  does  to  the  corium  ;  the  serous  membrane, 
or  arachnoid,  merely  unites  with  the  epithelium  of  the  ventricles.  This 
union  of  different  membranes  happens  in  woman,  in  respect  to  the  peri- 
toneum, and  in  birds  and  fishes.  The  nature  of  the  ventricular  epithe- 
lium is  ever  opposed  to  that  of  serous  membranes,  as  being  perforated 
by  numerous  blood-vessels."  And  Dr.  Knox,  eodem  loco,  says  : — u  The 
connection  of  the  cerebral  arachnoid  with  the  great  cerebral  fissure  of 
Vicq  d'Azyr  and  Bichat,  may  be  described  in  this  way: — Commencing 
with  the  base  of  the  brain,  where  the  fissure  commences,  and  tracing  it 
upwards  towards  the  upper  surface,  the  arachnoid  will  be  found  to  pass 
directly  over  the  fissure,  without  in  the  slightest  degree  dipping  into  it; 
and  this  is  a  fact  just  as  evident,  and  as  easily  made  out,  as  that  other 
fact,  viz.,  that  the  arachnoid  does  not  descend  between  the  cerebral  con- 
volutions. But  on  tracing  it  quite  up  to  the  part  of  the  fissure  which  is 
situated  between  the  corpora  quadrigemina  and  back  part  of  the  fornix 
and  corpus  callosum  united,  it  is  evident  that  the  arachnoid  does  form 

/ 

*  The  difference  between  the  two  surfaces  of  the  brain  will  be  thoroughly  explained 
hereafter. 


MEMBRANES,    ETC.  137 

a  short  canal,  precisely  in  the  situation  of,  and  around,  the  vena  magna 
Galeni.  How  far  this  canal  penetrates  it  is  somewhat  difficult  to  deter- 
mine ;  in  some  of  the  brains  I  have  examined,  it  scarcely  proceeded  an 
inch,  in  others  less ;  but,  however  this  may  be,  it  is,  I  think,  unques- 
tionable that  Bichat  committed  a  great  error  in  supposing  that  this  canal 
proceeded  into  the  interior  of  the  ventricles,  and  that  thus  a  passage  was 
established  between  the  ventricular  cavities  and  the  general  serous  cavity 
of  the  arachnoid.  If  we  now  return  again  to  the  commencement  of  the 
fissure  at  the  base  of  the  brain,  and  raise  up  the  arachnoid  from  off  the 
pia  mater,  which  here,  as  elsewhere,  lies  directly  beneath  it,  it  will  be 
found,  I  think,  that  the  arrangement  of  this  membrane  (the  pia  mater)  is 
very  similar,  in  respect  to  the  fissure,  as  with  the  common  cerebral  con- 
volutions and  anfractuosities.  For  first,  a  portion  of  it  passes  directly 
across  the  fissure;  secondly,  a  process  is  sent  inwards,  to  form  the  cho- 
roid  plexuses  and  velum  interpositum  ;  and,  thirdly,  at  the  edges  of  the 
fissure  the  pia  mater,  besides  adhering  very  closely  at  the  edge,  trans- 
mits a  perfectly  transparent  and  extremely  delicate  layer,  filamentous 
and  cellular,  but  not  vascular,  which,  investing  the  opposing  surfaces  of 
the  ventricular  walls,  constitutes  the  proper  ventricular  membrane;  in 
short,  the  processes  of  the  pia  mater,  which  dip  in  between  the  convo- 
lutions, might  almost  be  considered  as  analogous  to  the  choroid  plexuses, 
so  similar  are  they  in  their  arrangement,  and  perhaps,  also,  in  their  func- 
tions. A  similar  analogy  subsists  between  the  ventricular  lining  mem- 
brane, and  that  investing  the  opposing  surfaces  of  the  convolutions." 

With  this  account  by  Dr.  Knox  I  perfectly  agree. . 

Cruveilhier*  denies  the  continuity  of  the  arachnoid  membrane  with 
the  ventricular  membrane,  and  the  existence  of  the  foramen  of  Bichat. 

Burdachf  describes  the  arachnoid  as  not  entering  into  the  ventricles; 
that  the  epithelium  which  covers  them  is  too  delicate  to  be  continuous 
with  it,  and  that  which  appears  to  be  so,  is  rather  to  be  considered  as  a 
sheath  (Gefasscheide)  derived  from  it.f 

The  reflected  or  parietal  portion  of  the  arachnoid  is  closely  attached  to 
the  dura  mater,  but  the  tissue  cellulo-vasculaire  or  sub-arachnoid  is  in- 
terposed between  the  visceral  or  investing  portion,  and  the  pia  mater  of 
the  spinal  cord.  The  two  internal  surfaces  of  the  arachnoid  are  closely 
in  contact,  and  the  bag  which  is  between  them  is  generally  empty.  But 
not  so  the  sub-arachnoideal  cavity,  for  this  contains  the  important  cere- 
bro-spinal  fluid.  The  cerebral  portion  of  the  arachnoid  adheres  very 
intimately  to  the  pia  mater  at  certain  points,  leaving  in  the  intervals  a 
considerable  space  for  the  accumulation  of  the  liquid.  It  sinks  into  the 
great  longitudinal  fissure  of  the  brain,  lining  the  surfaces  which  bound  it 
on  either  side,  and  passing  across  from  right  to  left  beneath  the  inferior 
margin  of  the  falx,  and  above  the  great  transverse  commissure.  In  the 
same  way,  at  the  base  of  the  brain,  it  passes  over  the  fissura  Sylvii,  and 
diamoftd-shaped  space. 

Beneath  the  arachnoid  is  situated  the  pia  mater,  a  membrane  which 

•*••  •    >  -•*  ••; 

*  Op.  cit.,  t.  iv.  p.  700.  |  Page  24,  vol.  ii.  op.  cit. 

J  Mr.  Rainey  has  demonstrated  the  existence  of  a  very  abundant  supply  of  branches 
from  the  sympathetic  nerve  to  the  arachnoid;  his  paper  is  well  worthy  of  perusal:  Med.- 
Chir.  Trans.,  vol.  xxix.  p.  85.  . 


138  HUMAN    BRAIN. 

is  constructed  solely  for  the  purpose  of  supporting  the  vessels  distributed 
to  the  superficies  of  the  central  masses  of  the  nervous  system,  which  are 
so  numerous  that  they  require  an  especial  tissue  for  their  support.  This 
structure  dips  between  the  convolutions  of  the  brain,  at  the  same  time 
closely  investing  its  external  surface  ;  it  passes  also  over  those  surfaces 
which,  from  the  old  method  of  slicing  the  brain  from  above  downwards, 
appear  as  if  they  formed  the  walls  of  cavities  in  the  interior,  and  in  some 
of  these  situations  it  has  received  peculiar  names ;  among  the  most 
remarkable  of  its  portions  thus  indicated,  we  may  mention  the  plexus 
choroides  in  the  lateral  ventricles.  Dr.  Todd*  informs  us  "  that  very 
numerous  and  tortuous  blood-vessels  are  contained  in  these  processes, 
forming  a  plexus  which  has  given  name  to  the  folds  themselves.  The 
surface  of  each  choroid  plexus  presents  many  slight  projections  or  folds, 
resembling  villi,  in  which  are  contained  loops  and  plexiform  anasto- 
moses of  minute  vessels,  very  similar  to  the  arrangement  of  the  vessels  of 
the  villous  processes  of  the  chorion  of  the  ovum,  or  those  of  the  tufts  of 
the  placenta.  These  vessels  are  surrounded  by  an  epithelium  which  has 
much  the  appearance  of  that  of  serous  membranes.  From  the  great 
number  of  these  vessels,  and  from  the  delicate  nature  of  the  epithelial 
covering  which  surrounds  them,  it  is  plain  that  the  choroid  plexuses  are 
well  suited,  either  for  the  purpose  of  pouring  out  fluid,  or  of  absorbing 
it.  The  epithelium  may  be  best  seen  by  examining  the  edge  of  a  fold. 
It  becomes  very  distinct  when  acted  upon  by  acetic  acid.  As  its  parti- 
cles are  very  delicate,  and  consist  only  of  a  single  layer,  they  are  easily 
detached.  The  cells  of  the  epithelium  are  most  of  them  six-sided,  and 
contain  a  clear  nucleus,  or  several  minute  granules.  Valentin  states  that 
cilia  may  be  seen  playing  upon  this  surface,  especially  in  the  embryo. 
I  have  observed  the  peculiar  punctiform  or  spiniform  formations  to 
which  he  alludes,  which  look  like  the  remains  of  former  vibratile  cilia." 

Otto,  in  his  Compendium  of  Pathological  Anatomy,!  states  in  gene- 
ral, that  these  two  membranes,  the  arachnoid  and  pia  mater,  are  insepa- 
rably united  in  the  greatest  part  of  the  circumference  of  the  brain  in 
adults,  and  that  they  are  at  all  times  in  organic  connection  throughout 
by  means  of  fibre-mucous  tissue  of  various  length. 

It  will  be  instructive  to  dwell  for  a  few  moments  upon  the  admirable 
adaptation  of  these  three  cerebral  membranes  to  the  ends  of  their  forma- 
tion. The  dura  mater  forms  a  support  which  is  sufficiently  firm  and  un- 
yielding to  retain  the  brain  accurately  in  its  normal  position,  while  its 
processes  are  still  capable  of  yielding  to  a  certain  extent,  like  the  strong 
springs  of  a  carriage,  under  any  violent  concussion. 

The  arachnoid,  lining  the  dura  mater  and  covering  the  surface  of  the 
brain,  wholly  prevents  friction,  which  would  otherwise  be  inevitable, 
and  thus  answers,  in  its  situation,  the  same  end  as  the  synovial  mem- 
branes with  their  lubricating  secretion  in  the  various  joints  of  the  body, 
for  the  brain  is  never  in  a  quiescent  state,  but  is  constantly  rising  and 
falling  with  a  slight  pulsating  motion. 

The  immediate  agents  in  the  production  of  these  movements  appear 
to  be  the  circulating  and  respiratory  systems,  and  the  motions  are 

*  Loc.  cit.  f  Translated  by  M.  I.  F.  South,  p.  373,  note  i. 


CEREBRO-SPINAL   FLUID.  139 

therefore  twofold;  the  one  occasioned  by  the  pulsations  of  the  heart,  the 
other  by  the  movements  of*  the  chest ;  for  at  the  moment  that  cavity 
begins  to  be  contracted  for  the  expulsion  of  the  air,  the  return  of  the 
blood  from  the  brain  is  temporarily  impeded  ;  and,  on  the  other  hand, 
when  the  chest  begins  to  be  expanded  during  inspiration,  its  flow  is  in 
a  corresponding  degree  accelerated.  This  subject  has  been  much  and 
carefully  investigated,  as  a  reference  to  the  following  catalogue  of  authors, 
who  have  written  expressly  on  it,  given  by  Meckel,  in  vol.  iii.  p.  722, 
of  his  Anatomy,  will  prove.  Schlichting,  De  Motu  Cerebri,  in  the 
Mem.  Pres,.,  torn.  i.  p.  113  ;  Lorry,  Sur  les  Mouvements  du  Cerveau  et 
de  la  Dure-mere,  same  collection,  torn,  iii.,  Mem.  i.  p.  277,  Mem.  ii.  p. 
344 ;  Haller,  Experim.  ad  Motum  Cerebri  a  Refluxu  Sanguinis  natura, 
in  his  Opusc.  Phys.,  torn.  i.  p.  231;  Lamure,  Sur  la  Cause  des  Mouve- 
ments du  Cerveau,  in  the  Mem.  de  Paris,  1753  ;  Richard,  in  the  Jour, 
de  Med.,  torn,  xxix.,  1768,  Aout,  p.  140;  Ravina,  De  Motu  Cerebri,  in 
the  Mem.  de  Turin,  1811  ;  Portal,  Mem.  sur  un  Mouvement  qu'on  peut 
observer  dans  la  Moelle  epiniere,  in  his  Mem.  sur  plus.  Maladies, 
torn.  ii.  p.  81;  Magendie,  Sur  un  Mouvement  de  la  Moelle  epiniere 
isochrone  a  la  Respiration,  in  his  Jour,  de  Phys.  Exper.,  torn.  i.  p.  200. 

The  pia  mater  in  the  skull  is  of  just  sufficient  thickness  to  support  the 
vessels  without  interfering  with  the  motions  of  the  brain  :  but  in  the 
vertebral  canal  it  is  much  denser,  affording  a  better  support  to  the  cord, 
and  thus  performing  the  same  office  that  the  neurilemma,  or  investing 
membrane  of  the  nerves,  does  to  these  organs  in  their  extended  course 
through  all  parts  of  the  body. 

The  cerebro-spinal  fluid  next  deserves  our  attention.  The  existence 
and  situation  of  the  fluid  were  first  discovered  by  Haller  ;*  it  was  more 
clearly  described  by  Cotunnius,  in  a  memoir  entitled  "  De  Isehiade 
Nervosa  Commentarium,"  and  published  subsequently  by  Sandifort,. 
among  other  theses.  This  anatomist  was  struck  with  the  divsproportion 
of  the  spinal  canal  and  its  contents,  and  revolved  in  his  own  miad  how 
the  space  was  occupied.  These  statements  must  have  been  almost  for- 
gotten. Magendie  has,  however,  entered  more  minutely  into  the  whole 
physiology  of  the  matter.  He  first  published  his  discoveries  ia  I827r 
in  his  Journal  de  Physiologic,  and  more  fully  subsequently  in  1842,  as 
a  separate  quarto  treatise,  with  plates.  He  has  shown  that  if,  during  life> 
the  arches  of  the  vertebra  are  removed  in  a  horse,  dog,  or  other  animal, 
and  the  dura  mater  of  the  spinal  cord  punctured,  there  are  jets  of  a  fluid, 
which  previously  had  made  the  sheath  tense.  Immediately  afterdeath  the 
same  may  be  observed,  but  in  a  few  hours  the  greater  part  of  tfoe  fluid 
is  imbibed  by  the  surrounding  tissues. 

The  student  must  have  already  seen  that  the  brain  does  not  com- 
pletely fill  the  cranium,  that  the  spinal  cord  is  very  far  from  occupying 
the  whole  vertebral  canal.  In  old  persons,  particularly  in  such  as  have 
sunk  into  a  state  of  dementia,  the  condition  of  brain  is  very  striking  ; 
the  convolutions  are  narrow,  and  shrunk.  The  digital  fossae  are  large, 
and  contain  fluid.  The  seat  of  this  fluid  is  not  in  the  cavity  of  the 
arachnoid ;  there  are  two  distinct  localities.  First,  in  the  interspace 

*  Element.  Physiolog.,  vol.  iv.  p  87. 


140  HUMAN    BRAIN. 

between  the  arachnoid  and  pia  mater.  Second,  in  the  cavities  of  the 
cerebrum  and  cerebellum  in  the  human  subject ;  and  likewise  in  those 
of  the  olfactory  nerves,  optic  lobes,  and  spinal  cord,  of  some  animals. 

Thus  it  will  be  seen  that,  closely  as  the  arachnoid  in  many  points 
resembles  the  other  serous  membranes,  it  differs  in  this  important  point 
— that,  instead  of  adhering  closely  to  the  organ  it  invests,  as  the  peri- 
cardium does  to  the  heart,  it  is  separated  from  the  brain  by  a  tolerably 
wide  interspace,  in  which  the  fluid  is  situated.*  The  whole  spinal  cord 
is  bathed  in  this  fluid,  forming  a  layer,  wider  in  some  parts,  narrower  in 
others,  according  to  the  shape  of  the  canal  and  size  of  the  cord  in  differ- 
ent places.  One  result  of  its  presence,  even  in  those  situations  where  it 
is  least  abundant,  is,  that  the  nerves  float  in  it,  and  are  thus  kept  sepa- 
rate from  each  other,  instead  of  being  in  close  contact,  as  they  appear 
in  the  dead  subject.  In  the  skull  the  disposition  of  the  fluid  is  similar, 
and  the  nerves  are  bathed  in  it,  in  their  exit  from  the  cranium,  as  in  the 
spinal  canal. 

There  are  some  situations  where  it  accumulates  in  such  large  quanti- 
ties, that  they  may  be  called  confluences. 

1st.  The  largest  and  most  posterior,  situated  below  and  behind  the 
cerebellum. 

2d.  The  inferior — Between  the  crura  cerebri. 

3d.  Superior — Above  and  on  the  sides  of  the  pineal  gland. 

4th.  Anterior — Between  the  decussation  of  the  optic  nerves. 

5th.  Lateral — This  bathes  the  semilunar  ganglion  of  the  fifth  pair. 

It  is  still  a  question  whether  there  is  any  communication  between  the1 
fluid  of  the  ventricles  and  the  sub-arachnoid.  Magendie  states  "that 
there  is  an  opening  of  communication  at  the  calamus  scriptorius."  Dr. 
Todd  does  not  believe  in  the  existence  of  this  opening!  he  says,  "It  is 
not  necessary  to  have  recourse  to  such  a  supposition  to  account  for  the 
transmissibility  of  fluid  from  one  cavity  to  another,  for  the  pia  mater  is 
evidently  hygrometric,  and  will  readily  admit  of  the  passage  of  the  fluid 
through  it  by  endosmose  and  exosmose." 

There  is  no  reason  for  doubting  that  this  fluid  can  change  its  position 
during  life.  This  fact  has  not  escaped  the  observation  of  Dr.  Burrowes, 
who  remarks,  (p.  50,  on  Disorders  of  the  Cerebral  Circulation,  &c., 
1846,)  "  Pathological  states  of  the  spinal  column  in  children,  and  ex- 
periments upon  animals,  afford  opportunities  for  observing  the  changes 
in  the  site  of  the  cerebro-spinal  fluid  under  various  modifications  of 
pressure.  In  spina  bifida  it  may  be  remarked  that  the  spinal  tumor 
swells  and  becomes  tense  during  prolonged  expiration,  as  also  during  fits 
of  coughing  and  crying.  If  a  graduated  pressure  be  made  upon  the 
tumor  with  one  hand,  and  the  fontanelles  of  the  child  be  examined  with 
the  other,  in  proportion  as  the  spinal  swelling  decreases,  so  is  a  swelling 
of  the  brain  perceived,  accompanied  by  symptoms  which  usually  result 
from  pressure  on  the  brain  and  spinal  cord." 

Magendie,  in  his  estimate  of  the  quantity  of  this  fluid,  agrees  pretty 
closely  with  Cotunnius.  It  varies  according  to  the  age  and  size  of  the 
patient,  and  usually  bears  an  inverse  proportion  to  the  volume  of  the 

*  British  and  Foreign  Medical  Quarterly  Review,  October,  1842. 


REMOVAL    OF    THE    BRAIN.  141 

encephalon  ;  seldom  less  than  two  ounces,  and  often  amounting  to  five. 
In  old  age,  with  atropny  of  the  brain,  to  eight,  ten,  and  twelve  ounces. 
Magendie  regards  the  pia  mater  as  the  source  of  the  fluid.  When  this 
fluid  has  been  removed,  the  renewal  is  rapid,  as  in  the  case  of  the  hu- 
mors of  the  eye,  being  completely  secreted  again  in  twenty-four  hours. 

The  use  of  this  fluid  must  be  obvious  to  every  thoughtful  mind.  It  is 
a  mechanical  protection  to  the  brain  and  spinal  cord  against  the  violent 
shocks  and  vibrations  to  which  it  is  occasionally  exposed.  How  differ- 
ent would  be  the  condition  of  the  brain  without  this  soft  cushion,  or  the 
cord  of  it  hung  within  the  spinal  canal,  without  such  a  yielding  and  pro- 
tecting wall.  The  poor  invalid,  whose  bones  from  emaciation  are  nearly 
through  his  skin,  will  bear  his  testimony  to  the  value  of  a  fluid  couch,  if 
he  has  had  the  advantage  of  being  removed  from  an  ordinary  bed  to  Dr. 
Arnott's  water  bed.  Again,  let  the  medical  student  enter  an  anatomical 
museum,  and  observe  how  beautifully  the  preparations  of  the  spinal 
cord  float  in  the  spirit,  unexposed  to  the  shocks  and  blows  to  which  they 
would  be  subject  if  the  fluid  were  drawn  off  the  bottles,  and  they  were 
left  hanging  surrounded  merely  by  the  air. 

Chemical  Analysis  of  the  Cerebro- spinal  Fluid,  by  Lassaigne. 
Water  98-564 


Albumen    .          ^»«-  .          \\** 

Osmazome  .  .          i-'tmx- 

Hydrochlorate  of  soda  and  potass    . 
Animal  matter  and  phosphate  of  soda 
Carbonate  of  soda  and  phosphate  of  lime 


0-088 
0-474 
0-801 
0-036 
0-017 


99-980 


Removal  of  the  Brain. — The  next  step  is  to  remove  the  brain  from  the 
skull,  which  must  be  done  with  great  care,  as  the  nerves  which  are 
passing  from  the  cavity  of  the  cranium  are  easily  torn  through,  unless 
divided  with  a  very  sharp  knife  or  pair  of  scissors. 

The  fingers  of  the  operator  should  be  insinuated  under  the  anterior 
lobes,  and  the  cerebral  mass  raised  with  great  care  ;  the  first  pair  of 
nerves  which  he  will  observe  are  the  olfactory,  running  forward  to  the 
cribriform  plate  of  the  ethmoid  bone,  from  which  they  must  be  carefully 
detached.  The  next  pair  are  the  optic,  which  are  observed  gliding  un- 
der the  anterior  clinoid  processes,  and  quitting  the  skull  at  the  optic 
foramina,  where  they  may  be  divided,  as  well  as  the  internal  carotid 
arteries,  which  are  situated  immediately  on  their  outer  side.  The  next 
are  the  third  or  common  oculo-muscular  nerves;  these  penetrate  the 
dura  mater  midway  between  the  anterior  and  posterior  clinoid  processes. 
Immediately  after  their  division,  a  structure,  called  the  infundibulum, 
which  runs  directly  down  to  the  pituitary  gland  in  the  sella  turcica,  must 
be  cut  through. 

The  next  pair  are  the  fourth;  these  will  be  best  seen  by  gently  raising 
the  edge  of  the  tentorium  ;  and  being  the  smallest  of  the  cerebral  nerves, 
they  require  great  care  when  they  are  divided.  The  tentorium  itself 
must  next  be  cut  through:  and  the  nerves  situated  in  the  fossae  of  the 


142  HUMAN    BRAIN. 

skull  under  it,  will  be  discovered  in  the  following  rotation,  namely,  the 
fifth,  to  the  outer  side  of  the  posterior  clinoid  processes,  just  crossing 
the  superior  angle  of  the  petrous  portion  of  the  temporal  bone. 

The  sixth,  situated  on  a  plane  internal  to  and  beneath  the  fifth,  pene- 
trating the  dura  mater  about  half  an  inch  below  the  posterior  clinoid 
process. 

The  seventh  and  eighth,  or  facial  and  auditory  nerves,  pass  on  a  plane 
beneath  and  to  the  outer  side  of  the  fifth,  through  the  foramen  auditivum 
internum. 

The  ninth  and  tenth,  or  glosso-pharyngeal,  and  par  vagum,  with  the 
spinal  accessory,  are  immediately  below  the  last ;  and  the  eleventh,  or 
lingual,  lie  rather  lower  down,  but  to  the  inner  side.  These  being 
divided,  the  spinal  cord  and  vertebral  arteries  must  be  cut  through  by 
pushing  the  knife  as  low  down  into  the  vertebral  canal  as  can  be  con- 
veniently effected. 

The  left  hand  of  the  operator  (his  right  being  engaged  in  supporting 
the  brain)  must  then  be  placed  beneath  the  cerebellum,  leaving  the 
spinal  cord  between  his  middle  and  ring  finger,  and  the  whole  encephalon 
be  removed.* 

Removal  of  the  Spinal  Cord. — For  the  purpose  of  removing  the  spinal 
cord,  the  student  had  better  make  an  incision  through  the  skin  directly 
over  the  spinous  processes  of  the  whole  vertebral  column  ;  and  next 
dissecting  the  muscles  from  them  and  the  surfaces  of  the  arches,  he  will 
be  able  to  use  the  saw,  with  which  he  must  cut  completely  through  the 
arches  of  the  two  or  three  lowermost  cervical  vertebra  on  both  sides  ; 
having  entirely  removed  these,  he  can  divide  the  remainder  of  the  arches 
by  means  of  a  strong  pair  of  bone  scissors  made  expressly  for  the  purpose. 

Having  thus  opened  the  whole  of  the  vertebral  canal,  he  will  observe 
the  dura  mater  completely  investing  the  cord,  but  not  in  contact  with 
the  arches  of  the  vertebra,  from  which  it  is  separated  by  a  layer  of  soft 
reddish  fat,  which  is  most  abundant  in  the  sacral  region.  The  spinal 
plexus  of  veins  is  lodged  in  this  soft  bed. 

The  dura  mater  forms  a  complete  canal  for  the  medulla  spinalis,  and 
also  branches  off  with  each  of  the  spinal  nerves,  which  it  accompanies 
as  far  as  the  vertebral  foramina,  to  the  edges  of  which  it  is  attached,  each 
attachment  performing  to  the  whole  the  office  of  ligaments,  which  retain 
the  cord  accurately  in  its  normal  situation.  At  the  lower  extremity  of  the 
vertebral  canal  in  the  sacrum,  it  ends  in  a  bluntish  point  by  fibrous  pro- 
cesses which  are  attached  to  the  os  coccygis.  These,  like  the  stay-ropes 
of  the  mast  of  a  vessel,  steady  the  cord  in  the  interior  of  its  bony  case. 

The  Arteries,  which  are  very  numerous,  are  derived  from  the  verte- 
bral, the  occipital,  deep  cervical,  intercostal,  lumbar  and  sacral  arteries, 
and  supply  not  merely  the  membranes,  but  the  substance  of  the  cord. 
The  veins  are  very  numerous  and  large,  forming  intricate  plexuses, 
which  are  more  numerous  in  the  cervical  and  lumbar  than  in  the  dorsal 
region.  They  have  been  accurately  described  and  beautifully  figured 
by  Breschet;  anteriorly  they  form  on  the  bodies  of  the  vertebra  large 
sinuses,  long  known  as  the  longitudinal  spinal  sinuses.  The  cross 

*  These  last  directions  apply  only  in  those  cases  where  the  pupil  is  unavoidably  pre- 
vented removing  the  spinal  cord  in  connection  with  the  brain. 


MEMBRANES   OF   THE   CORD.  143 

branches  opposite  the  centres  of  the  bodies  of  the  vertebrae  communicate 
with  long  venous  canals  which  traverse  the  spongy  texture  of  these 
bones  (see  fig.  "70,  12). 

They  differ  from  the  sinuses  of  the  brain,  in  not  being  enclosed  in  two 
layers  of  the  dura  mater. 

The  cord  may  next  be  removed  in  connection  with  the  brain  by  cut- 
ting through  the"  dura  mater  and  each  spinal  nerve,  as  it  quits  the  canal, 
commencing  with  the  lowest  sacral,  and  then  drawing  it  through  the 
foramen  magnum. 

Having  removed  the  cerebro-spinal  axis  from  its  canal,  the  dissector 
must  proceed  carefully  to  divide  the  dura  mater  along  the  mesial  line, 
and  he  will  then  observe  the  arachnoid  loosely  investing  the  cords,  and 
forming,  by  the  addition  of  some  tendinous  fibres,  a  tooth-like  ligament 
between  the  anterior  and  posterior  roots  of  each  of  the  spinal  nerves, 
called,  from  its  appearance,  the  ligamentum  denticulatum.  This  struc- 
ture is  considered  by  F.  Arnold  to  be  formed  by  processes  of  the  dura 
mater,  similar  to  those  which  are  met  with  in  the  skull.  By  Dr.  Knox 
it  is  considered  as  analogous  to  certain  tendinous  shining  cords  connect- 
ing the  cerebral  arachnoid  to  the  pia  mater.  To  me  it  appears  evidently 
a  continuation  of  the  arachnoid  with  some  superadded  fibres,  and  serves 
the  purpose  of  hanging  the  cord  to  the  interior  of  the  canal  of  the  dura 
mater.  It  also  affords  additional  protection  to  the  soft  and  yielding 
neurine  of  which  the  whole  spinal  nervous  mass  consists,  retaining  it  in 
its  situation,  and  supporting,  but  without  exerting  the  slightest  pressure 
upon  it. 

The  arachnoid  being  now  carefully  removed,  the  dissector  will  find  a 
tolerably  firm  membrane  underneath  it ;  this  is  the  pia  mater,  which  is  so 
much  less  vascular  than  that  investing  the  cortical  structure  of  the  brain, 
that  some  anatomists  have  considered  it  as  a  distinct  membrane.  When, 
however,  we  consider  that  the  exterior  of  the  cord  is  formed  of  medul- 
lary, and  not  of  cineritious,  neurine,  which  is  so  much  more  vascular, 
we  can  understand  the  reason  of  the  vessels  being  fewer  in  number,  and 
thus  account  for  the  existence  of  a  pia  mater  altered  in  its  general 
appearance. 

The  pia  mater  sends  processes  with  the  nerves,  which,  forming  their 
material  and  investing  membrane,  constitutes  what  is  called  the  neurilemma 
of  the  nerve.  At  the  inferior  extremity  of  the  cord,  the  pia  mater  tapers 
off  to  a  point,  and  is  prolonged  as  a  fibrous  string  to  be  inserted  into  the 
dura  mater.  It  is  called  the  filiform  prolongation  of  the  pia  mater.  u  The 
late  Dr.  Macartney,"  says  Dr.  Todd,*  "  used  to  regard  it  as  highly  elastic, 
but  my  friend  Mr.  Bowman  has  called  my  attention  to  the  fact,  that  it 
consists  almost  entirely  of  white  fibrous  tissue,  which  cannot  confer  elas- 
ticity; and  if  a  portion  removed  from  the  cord  be  stretched,  it  will  be 
found  to  possess  very  little  elasticity;  but  if  the  cord  be  held  up  by  the 
filiform  prolongation,  and  a  slight  jerking  movement  be  communicated 
to  it,  it  may  be  made  to  dance  about  as  if  by  the  elastic  reaction  of  the 
filiform  process.  The  movements  which  may  be  thus  produced  are  very 
well  calculated  to  deceive,  and  Dr.  Macartney  must  have  founded  his 

*  LOG.  cit. 


144  HUMAN    BRAIN. 

opinion  upon  that  experiment  alone,  omitting  to  try  the  effect  of  stretching 
a  detached  portion  of  the  process.  The  fact  is,  that  when  the  cord  is 
suspended  in  this  way,  the  pia  mater  becomes  stretched,  and  its  anterior 
and  posterior  portions  are  approximated  and  the  cord  flattened.  When 
it  is  raised  with  a  jerk,  this  tension  of  the  pia  mater  is  diminished,  and 
the  cord  returns  to  its  previous  state  until  it  again  stretches  the  pia  mater 
and  becomes  once  more  flattened,  producing  a  degree  of  reaction  which 
favors  its  elevation,  but  which  alone  would  be  insufficient  for  that  pur- 
pose." 

Thus,  it  appears  that  the  elastic  reaction  which  Dr.  Macartney  attri- 
buted to  the  filiform  process,  is  in  reality  due  to  the  compression  and 
consequent  flattening  of  the  cord  by  the  tension  of  the  pia  mater.  It 
should  be  stated  further,  that  this  process  is  not  formed  of  pia  mater  alone, 
but  also  of  a  continuation  of  the  ligamentum  denticulatum  on  each  side. 


145 


PART    IV. 

WEIGHT  OF  THE  HUMAN  BRAIN. 

IN  tracing  the  gradual  development  of  the  nervous  system  of  the 
animal  kingdom  up  to  man,  the  student  will  have  observed,  in  all  the 
specimens  ordinarily  within  his  reach,  the  actual  inferiority  as  regards 
size  and  weight  of  the  brain,  even  of  the  higher  animals,  as  compared 
with  man.  The  brain  of  the  horse,  for  instance,  is  not  merely  smaller 
relatively  to  the  body  than  that  of  the  human  being,  but  actually  so. 
Indeed,  the  only  exception  to  this  rule  is  met  with  in  the  brain  of  the 
elephant  and  the  whale — the  brain  of  the  elephant  weighing  from  8  to 
10  Ibs. ;  and,  according  to  Rudolphi,  that  of  a  whale,  75  feet  long, 
(Balcena  mysticetus,)  weighed  5  Ibs.  10J  oz.,  but  that  of  a  narwhal,  17 
to  18  feet  long,  (Monodon  monoceros,)  only  2  Ibs.  3  oz. 

It  is  to  be  remembered  that  these  observations  apply  to  the  encephalon, 
the  whole  brain,  and  not  to  the  hemispherical  ganglia,  which  we  believe 
to  be  the  portion  immediately  connected  with  the  intellectual  powers. 

Agreeing  with  Professor  Muller,  that  all  the  primitive  fibres  of  the 
nerves  of  volition  and  of  sensation  are  actually  continued  into  the  brain, 
I  believe  that  the  great  bulk  of  the  brain  of  brutes  is  made  up  of  the 
fibrous  neurine  which  traverses  their  body  in  the  form  of  nerves.  At 
the  same  time  it  is  to  be  remembered  that  the  great  bulk  of  the  nerves 
of  animals  is  composed  of  strong  membranous  envelops  to  each  fibre, 
and  not  solely  of  neurine.  The  increase  of  size  which  is  thus  given  to 
a  nerve  is  well  seen  in  the  portio  dura  or  facial  nerve  of  the  human- 
subject.  Compare  this  nerve  at  its  origin  in  the  medulla  oblongata, 
before  it  can  receive  a  covering  from  the  pia  mater,  and  the  same  nerve 
after  it  has  quitted  the  skull  by  the  stylo-mastoid  foramen. 

Many  observations  have  been  made  on  the  weight  of  the  huma-n  brain, 
from  the  time  of  Haller  to  the  present  period ;  the  latest  and  most  ex- 
tensive are  by  that  indefatigable  and  excellent  physiologist,  Dr.  John 
Reid,  published  in  the  London  and  Edinburgh  Monthly  Journal  of  Me- 
dical Science  for  April  1843.  Dr.  Sims,  who  has  an  excellent  paper 
on  Atrophy  and  Hypertrophy  of  the  Brain,  in  vol.  xix.  of  the  Medico- 
Chirurgical  Transactions,  after  giving  the  conclusions  of  Haller,  Soem- 
merring,  and  Sir  Wm.  Hamilton,  gives  tables  of  his  own.  From  these 
sources  we  learn  that  the  average  weight  of  the  adult  human  male  brain 
is  about  3  Ibs.  That  it  increases  from  1  year  old  up  to  20.  Between 
20  and  30  there  is  a  slight  decrease  on  the  average  ;  afterwards  it 
increases,  and  arrives  at  its  maximum  between  40  and  50;  to  old 
age  the  brain  gradually  decreases  in  weight.  Tiedemann,  in  his  paper 
10 


146  HUMAN    BRAIN. 

on  the  brain  of  the  negro,*  states  that  the  hrain  of  the  adult  male  varies 
between  3  Ibs.  2  oz.  and  4  Ibs.  6  oz.  The  brain  of  men  who  have 
distinguished  themselves  by  their  talents,  is  often  large;  the  brain  of 
Cuvier  weighed  4  Ibs.  11  oz.  4  dr.  30  gr.  troy  weight;  that  of  Dupuy- 
tren  4  Ibs.  10  oz.  troy  weight.  The  brain  of  an  idiot,  50  years  of  age, 
weighed  only  1  Ib.  6  oz.  4  dr.;  and  another,  40  years  of  age,  weighed 
but  1  Ib.  11  oz.  4  dr.  The  female  brain  usually  is  lighter  than  the  male. 
It  varies  between  2  Ibs.  6  oz.  and  3  Ibs.  1 1  oz.  Tiedemann  never  met 
•with  a  female  brain  that  weighed  4  Ibs.  The  female  brain  weighs  on  an 
average  from  4  to  6  ounces  less  than  that  of  the  male;  and  this  differ- 
ence is  already  perceptible  in  the  new-born  child. 

It  is  curious  that  Rudolph  Wagner,  whose  name  as  a  physiologist 
stands  deservedly  high,  should  make  the  following  statement  regarding 
the  growth  of  the  brain  :f — "  With  the  second  dentition  in  the  course  of 
the  seventh  and  eighth  years,  the  brain  seems  to  attain  its  complete  de- 
velopment in  point  both  of  form  and  weight,  and  its  several  parts  now 
represent  the  relations  which  they  preserve  through  the  whole  of  after- 
life." Dr.  Willis  has  the  following  excellent  observations  on  this  pass- 
age:— "This  is  surely  a  physiological  error;  on  taking  measurements  of 
the  heads  of  fifteen  children,  between  7  and  8  years  of  age,  I  find  the 
mean  circumference  to  be  20^ inches;  but  the  mean  circumference  of 
the  head  in  ten  children  between  13  and  14  years  of  age  in  the  same 
school,  taken  as  they  stood,  and  without  selection,  is  21^  inches.  If 
the  size  of  the  skull  represent  the  size  of  the  brain,  therefore,  the  brain 
is  not  so  large  at  8  years  of  age  as  it  is  at  14 ;  neither  is  it  so  large  at 
14  or  15  as  it  is  at  20  and  25.  On  making  the  inquiry  at  several  of  the 
large  hat  shops  of  the  metropolis,  whether  or  not  there  was  any  differ- 
ence in  the  sizes  of  hats  required  for  boys  of  between  7  and  8  years  of 
age,  and  full-grown  men,  I  was  assured  there  was  a  very  considerable 
difference:  that  the  sizes  of  youths  of  7,  8,  and  9,  were  what  are  desig- 
nated the  6|,  6f ,  and  6f  sizes,  whilst  for  grown  men  the  mean  average 
size  is  about  7,  or  from  that  to  7J.  The  numbers  here  represent  the 
mean  between  the  long  and  the  lateral  diameters  of  the  head.  A  London 
hatter  says:  '  The  head  I  have  always  found  to  attain  its  full  dimensions 
in  accordance  with  the  bodily  frame.  I  fix  the  utmost  limit  my  experi- 
ence will  allow  at  25  years.  The  more  general  period  of  full  attainment 
of  size  is  between  17  and  23.  Many  heads  are  at  their  full  size  at  the 
age  of  16.'" 

The  Tables  which  follow  over  leaf  are  from  Dr.  Reid. 

*  Phil.  Trans.,  1836.  t  °P-  cit->  P-  616- 


7    M    ' 


WEIGHT    OF   THE    BRAIN. 


147 


TABLE  I. 
WEIGHT  USED  AVOIRDUPOIS. 

Exhibiting  the  Heaviest,  Lightest,  and  the  Average  Weight  of  Encephalon,  Cerebellum,  and 
Cerebellum  with  Pons  Varolii  and  Medulla  Oblongata,  at  different  ages,  in  '253  Brains. 
Though  individual  female  brains  are  not  unfrequently  found  to  be  heavier  than  indivi- 
dual male  brains,  yet  as  the  average  male  brain  is  several  ounces  heavier  than  the  average 
female  brain,  it  is  necessary  that  these  be  ranged  in  separate  tables; — the  more  especially 
wheii  the  number  of  brains  at  different  ages,  weighed  in  the  two  cases,  do  not  correspond. 


a 

HEAVIEST. 

LIGHTEST. 

AVERAGE. 

Age. 

iber  weigh 

Bj 

1 

Ill 

CJ 

2. 
a 
te 

Q. 

bellum. 

s-3 

1!| 

1 
1 

'u 

g«rf 

ill 

E 

1 

Pi 

1 

§ 
o 

I'1! 

1 

1 

i" 

/ 

Years. 
1—4 

5 

oz.      dr. 
45     4 

oz.  dr 
4  10 

oz.      dr 
5     6- 

oz.      dr. 
27      8 

oz.dr 

2     8 

oz.      dr. 
3     0 

oz.      dr 
39     4| 

oz.      dr. 
3   13* 

oz.     dr. 
4     6| 

5-7 

3 

47   10i 

5     1 

6     0 

40  12 

4     0 

4     9 

43   10 

4     7 

5     6 

7—10 

6 

52  14 

5     0 

5  11 

40   12 

4     0 

4  10 

46     2| 

4  lOf 

5  10ft 

10—13 

3 

51     2 

5     2 

6     2 

43     8 

4     9 

5     6 

48     7s 

4  14 

5   12 

13—16 

5 

50     2 

5     8 

6     8 

43   10 

0     0 

5  10 

47     8f 

— 

6      li 

16—20 

6 

56     0 

6     1 

7     2 

48     0 

4     8 

5     8 

52  lOf 

5     4i 

6     6T*j 

A 

20—30 

25 

58     0 

6     0 

7     0 

45     8 

4   12 

5     4 

50     9| 

5     3i 

6     2 

!/ 

30—40 

23 

62     8 

5   14 

8     8 

40   10 

4     6 

5     1 

51    15i 

5     3i 

6     4i 

%\ 

40—50 

34 

53     8 

6     4 

7   10 

34     0 

4     8 

5     6 

48   13i 

5     3| 

6     4T6r 

50—60 

29 

59     0 

7     0 

8     4 

39     0 

4     8 

5     4 

50     2 

5     5T8ff 

6     20\ 

60—70 

8 

60     4 

6     3 

7     4 

40     0 

4     2 

5     2 

50     6f 

5     0 

6     2" 

70  and 
upwards 

!7 

54  10 

5     8 

6     8 

43     8 

4     8 

5     4 

48     4f 

4   14 

5   14f 

Total  male"} 

brains      > 

154 

. 

weighed  _) 

. 

2—4 

6 

42     0 

4     0 

4   10 

32     0 

3     5 

3   15 

37     9 

3     9^ 

4     5 

5—7 

3 

41     8 

4     0 

4     8 

36     0 

3     5 

4     0 

39     1£ 

3   11 

4     8f 

7—8 

3 

43   14 

4  10 

5     9 

40     8 

4     4 

5     0 

42     7i 

4     7| 

5     5 

10—13 

1 

43     8 

5     2 

6     2 

— 

— 

— 

— 

— 

— 

13—16 

1 

41     0 

4     8 

5     8 

— 

— 

— 

— 

— 

— 

16—20 

8 

49   12 

5     8 

6     4 

41     8 

4   12 

5     6 

44  ni 

4  14£ 

s  nil 

20—30 

18 

50     0 

5     2 

6     2 

39     2 

4     0 

4  12 

45     2f 

4  m 

5     9* 

d 

30—40 

23 

51     0 

5     8 

6     8 

39   14 

4     2 

5     0 

44     li 

4   13* 

5  11 

j 

40—50 

18 

50     6 

6     0 

7     0 

36  12 

3   12 

4     4 

44   I0f 

4   14 

5  144 

<  ( 

50—60 

5 

48     6 

4  12 

5  15 

43     4 

4     4 

5     2 

45     44, 

I     7* 

5     8| 

1 

60—70 

1 

46  10 

5     2 

6     0 

36     2 

4     2 

5     0 

42  14f 

4   10ft 

5     9 

70  and 
upwards 

i2 

46     0 

5     1 

6     0 

31      1 

3   10 

4     5 

38     8^ 

4     5£ 

5     2* 

Total      , 

female     / 

qq 

brains     ( 

*7l7 

. 

^ 

weighed   ' 

An  examination  of  Table  I.  does  not  afford  any  support  to  the  supposition  of  some,  that  the 
cerebellum  attains  its  maximum  weight  at  seven  years  of  age,  and  the  cerebrum  its  maximum 
weight  nearly  at  the  same  period,  or  only  a  little  later.  There  appears  to  be  little  dou.bt, 
however,  from  all  the  facts  which  have  been  collected  on  this  subject,  that  the  brain  arrives 
at  its  maximum  weight  sooner  than  the  other  organs  of  the  body,  and, to  judge  from  a  few' 
measurements  we  have  made  of  the  length  of  the  corpus  callosurh,  the  depth  of  the  gray 
matter,  the  length,  breadth,  and  depth  of  the  corpus  striatum  and  thalamus,  we  would  be 


148 


HUMAN    BRAIN. 


inclined  to  conclude  that  the  relative  size  of  these  parts  is  the  same  in  the  young  person  as 
in  the  adult.  We  believe  that  there  can  be  little  doubt  that  the  relative  size  of  the  brain  to 
the  other  organs,  and  to  the  entire  body,  is  much  greater  in  the  child  than  in  the  adult.  In 
Table  III.  will  be  found  the  results  we  have  obtained  on  this  point.  In  Table  II.  we  find 
less  difference  between  the  relative  weight  of  the  encephalon  and  cerebellum,  at  different 
periods  of  life,  than  we  had  been  led  to  expect  from  some  statements  which  have  been  made 
upon  this  question.  The  data  we  have  collected  do  not  entitle  us  to  speak  positively,  but  as 
the  other  statements  to  which  I  refer  seem  principally  to  rest  upon  the  vague  and  uncertain 
measurements  of  the  eye,  we  may  reasonably  request  to  be  allowed  to  suspend  our  opinion 
of  their  accuracy,  until  we  have  a  sufficient  amount  of  materials  brought  before  us  to  justify 
us  in  giving  a  decided  judgment.  In  looking  over  the  column  of  the  average  weights  of  the 
encephalon,  at  different  ages,  in  Table  I.,  we  can  not  fail  to  experience  some  surprise  at  the 
difference  between  the  average  weight  of  that  organ  in  the  male,  between  1 6  and  20  years 
of  age  and  between  40  and  50,  but  we  cannot  for  a  moment  have  any  hesitation  in  deciding 
that  this  must  arise  from  sources  of  fallacy  incident  to  insufficient  data.  In  the  group  be- 
tween 40  and  50  years  of  age  some  brains  much  below  the  average  weight  are  found,  and 
there  can  be  no  doubt  that  it  is  to  this  accidental  circumstance  that  we  must  attribute  the 
diminution  in  the  average  weight  of  the  brain  in  that  group.  Among  the  females,  we  find 
a  decided  diminution  in  the  average  weight  of  the  brain  above  60  years  of  age,  while, 
among  the  males,  this  is  not  apparent  until  a  later  period.  We  certainly  did  expect  also  to 
find  a  similar  diminution  in  the  average  weight  of  the  male  brain  above  60  years  of  age,  for 
we  are  perfectly  satisfied,  as  the  tables  containing  the  individual  facts  will  show,  that  we 
more  frequently  meet  with  a  greater  quantity  of  serum  under  the  arachnoid  and  in  the  lateral 
ventricles  in  old  people,  than  in  those  in  the  prime  of  life.  We  are  also  satisfied,  from  an 
examination  of  the  notes  we  have  taken  at  the  time  the  brains  were  examined,  that  a  certain 
degree  of  atrophy  of  the  convolutions  of  the  brain  over  the  anterior  lobes,  marked  by  the 
greater  width  of  the  sulci,  was  more  common  in  old  than  in  young  persons.  We  have,  how- 
ever, frequently  remarked  these  appearances  in  the  brains  of  people  in  the  prime  of  life, 
who  had  been  for  some  time  addicted  to  excessive  indulgence  in  ardent  spirits. 


TABLE  II. 

Relative  Weight  of  Encephalon  to  Cerebellum,  and  to  Cerebellum  with  Pons  Varolii  and 
Medulla  Oblongata,  at  different  ages,  in  172  bodies.* 


MALE! 

k 

| 

FBI 

1ALES. 

Cerebel- 

Cerebel- 

Number 

lum  with 

Number 

Cerebel 

Number 

lum  with 

Number 

Ages. 

Cerebellum 

weighed 

pons  Va 
rolii  and 

weighed 

luiu 

weighed. 

pons  and 
medulla 

weighed. 

medulla. 

oblongata 

1  to  5  years 

1  to  lOf 

5 

to  8J  f 

5 

1  to9T9, 

4 

to  8j$ 

5 

57" 

9  A 

3 

8F 

3 

1           10j7A 

2 

8i 

3 

7     10     « 

9  15? 

I 

8jV 

5 

1     9£ 

3 

8 

3 

10     13     " 

9f» 

3 

8i5j 

3 

— 

— 

— 



13     15     « 

9TT 

1 

JH 

4 

— 

— 

— 

— 

16     20     " 

9j$ 

4 

8T7 

4 

1     9ft 

5 

T| 

5 

20     30     " 

9|' 

13 

8| 

13 

1       9ZJ 

12 

8 

12 

30     40     " 

9M 

11 

11 

9fr 

15 

8ft 

15 

40     50     « 

V* 

23 

8*? 

23 

91 

9 

7*1 

9 

50     60     « 

||| 

]7 

4 

17 

10 

4 

8f 

4 

60     70     « 

1        10ft 

5 

N 

8 

938<T 

11 

7§l 

11 

70  &  upwards 

1         9f 

5 

8^ 

7 

8lf 

2 

2 

2£  years 

__ 

__  _ 

__ 

— 

1   10SV 

4 

1       8i 

4t 

4  months 
1  year 

1        11 

1 
1 

89ff 

1 
1 

— 

— 

— 

*"  In  ascertaining  the  relative  weight  of  the  cerebellum  to  the  encephalon,  those  encephala 
only  were  selected  in  which  the  cerebella  were  also  weighed  The  same  plan  was  also 
followed  in  ascertaining  the  relative  weight  of  the  cerebellum  with  pons  and  medulla  oblon- 
gata to  the  encephalon. 

t  Three  of  the  youngest  cases  included  in  the  above  Table  given  separately. 


WEIGHT   OF   THE    BRAIN, 


O5  Ox 

O  O 


*-  CO  tO  i-i 

O  O  O  CO 


3  £ 

! 


COCOCOCOCOCOtOi— *|  CO  CO  CO  CO  CO  I— » 

OOOOOxJ^COOlOCO          OO          COCiOO^lO'Ox 


as  to  ox  oo  >£.  co  '  co  ' 


it*  rfi.  ^  CO  CO  CO  1  M*  1 

CO  K-  —  CO  <»  —    OX 


IO  *».  OS  £>•  CO  '  CO  ' 


00  CO  CO  CO  CO  tO  1  h-  1 

,£».  ~4  (O  ,_.  tO  00    to    OO 

01  O  4-^  <31  -J  CO    Or    4^ 


CO  CO  CO  CO  I-"  i-i 


tocotototo^-l    i-*|  cocotocotoi-* 

i-»          OX          i-i          OOOOOiO5COO5&Gi-iOi 


o>to*».a>*>.co'  co 


'  o' 


I1 


^l  a_  1  &o  co  1  to  1  to 

Ox  |  (0  1  CO  0    (0    0 


ll 


«>  c* 


a  p1^  I 


i 

si 

M 


s 


R 


t 

II 


II 


I 
&*  3 


1  « 


150 


HUMAN    BRAIN. 


TABLE  IV. 

Average  weight  of  the  Encephalon,  &c.,  between  25  and  55  years  of  age,  in  the  two 

sexes,  and  the  average  difference  between  them. 
Males,  53  brains  weighed. — Females,  34  brains  weighed. 


Average  weight  of  Encephalon 

.  .     Cerebrum   -    -    - 

.  .     Cerebellum      -     - 

,     Cerebellum    with 


and  medulla  oblongata  j 


Male. 

oz.     dr. 
50     3£,  or 
3  Ibs.  2  oz.  3£  dr. 

-  43   15| 

-  5     4 
pons  ) 


6     3| 


Female.  Difference  in  favor 

of  the  Male. 
oz.    dr.  oz.     dr. 

44     8$,  or        5  11 
2  Ibs.  12oz.  8idr. 
38   12  5     3| 

4  12*  0     7£ 

5  12£  0     7$  nearly. 


TABLE  V. 

Relative  weight  of  Encephalon  to  Cerebellum,  and  to  Cerebellum  with  Pons  Varolii 
and  Medulla  Oblongata,  between  25  and  55  years  of  age,  in  the  two  sexes. 
53  male,  and  34  female  brains  weighed. 


Male.  Female. 

as  1  to  9f   as    1  to  9* 
1       8  1       7» 


.Relative  weight  of  Encephalon  to  cerebellum  -    -    - 

Encephalon  to  cerebellum  with  pons  and  medulla       1       8^ 

From  this  table  it  would  appear  that,  in  the  female,  the  average  cerebellum  is  rela- 
tive to  the  encephalon,  a  little  fceavier  than  in  the  male. 


TABLE  VI. 

Relative  Weight  of  the  entire  Body  to  the  Encephalon,  the  Heart,  and  Liver,  in  the 
two  sexes  between  25  and  55  years  of  age. 


Number 
Encephalon.  weighed. 


Male     -    -    -    as  1  to  37$ 
Female      -    -          1      35 


33 
15 


as 


Heart. 
1   to    1691 
1        176 


Number 

weighed. 

37 

12 


Number 

Liver.  weighed. 

1  to  35|  31 

1        39  7 


As  far  as  this  Table  enables  us  to  judge,  it  would  appear  that  though  the  average 
male  brain  is  absolutely  heavier  than  that  of  the  female,  yet  that  the  average  female 
brain,  relative  to  the  weight  of  the  whole  body,  is  somevyhat  heavier  than  the  average 
male  brain. 


TABLE  VII. 

In  9  Males,  between  27  and  50  years  of  age,  who  died  either  immediately,  or  within 
a  few  hours  after  accidents  and  other  external  causes  of  sudden  death,  arid  who 
had  been  previously  in  good  health,  the  following  results  were  obtained: 


Average  weight  of 

Average  of  ence- 

Average of 

body  (9  weighed). 

phalon  (6  weighed). 

cerebellum 
(4  weighed). 

oz.  dr. 

oz.  dr. 

9st.  8  Ibs.,  3i  oz.,  or 

52  4|,  or 

5  7£ 

134  Ibs.  3$  oz. 

3lbs.4oz.4f  dr. 

Average  of  heart 
(9  weighed). 

oz.  dr. 
12   6 


Average  of  cerebellum  with 
pons  and  medulla  (5  weighed). 

oz.  dr. 
6   6 

or,  taking  the  average  of  the 

four  cases  only  in  which  the 

cerebellum  was  taken, 

6  oz.   7$  dr. 

Relative  weight  of  body  to  encephalon  (6  weighed)      -,    -    -    -    -    as  1  to  40f 

.  .      to  heart  (9  weighed)       .......          1  173| 

encephalon  to  cerebellum  (4  weighed)      ...          l  9| 

..     tocerebellum  with  pons  and  medulla  (5  weighed)  1  8T6? 

Though  the  data  from  which  the  above  Table  is  constructed  are  very  limited,  yet 
we  may  be  allowed  to  remark,  that  the  greater  relative  weight  of  the  encephalon  to 
the  bod'y,  in  those  emaciated  by  disease,  than  in  those  cut  off  while  in  possession  of 
health  and  muscular  vigor,  which  it  indicates,  is  what  we  would  expect  from  other 
considerations.  There  is  little  difference  in  the  relative  weight  of  the  cerebellum  to 
the  encephalon  in  the  two  classes  of  cases. 


WEIGHT   OF    THE    BRAIN.  151 

My  friend  and  colleague,  Dr.  T.  B.  Peacock,  has  also  published  some 
admirable  tables  in  the  Monthly  Journal  of  Medical  Science,  for  1846, 
from  which  he  draws  the  following  conclusions  : — 

"  1st.  The  encephalon  in  the  adult  male  weighs,  on  an  average,  50 
oz.  3-25  dr.,  or  3  Ib.  2  oz.  and  3T3g4T  drachms  avoirdupois,  and  exceeds 
in  weight  that  of  the  female  by  5  oz.  4-95  dr.,  the  latter  weighing  on  an 
average  44  oz.  and  14-3  dr.,  or  2  Ib.  12  oz.  14^f  dr. 

14  Of  131  male  brains  weighed,  the  heaviest  was  62  oz.  12  dr.,  or  12 
oz.  8-75  dr.  above  the  mean  ;  the  lightest  was  34  oz.,  or  16  oz.  3-25 
dr,  below  it. 

"  Of  74  female  brains,  the  extremes  were  54  oz.,  or  9  oz.  1-7  dr. 
above  the  average,  and  36  oz.  12  dr.,  or  8  oz.  2-3  dr.  below  it. 

44  Of  the  male  encephala,  8'3  per  cent,  were  under  45  oz.  in  weight, 
74-04  per  cent,  weighed  between  45  and  55  oz.,  and  17-5  per  cent,  ex- 
ceeded 55  oz.  in  weight. 

44  Of  the  female  encephala,  54  per  cent,  weighed  under  45  oz.,  45-9 
per  cent,  were  between  45  and  55  oz.  in  weight,  arid  none  exceeded 
55  oz. 

"Note. — A  comparison  of  these  averages  with  those  deduced  by  Dr. 
Reid,  will  show  that  they  correspond  very  closely,  though  the  numbers 
on  which  the  calculations  are  based  are  considerably  extended.  They 
do  not  differ,  also,  very  greatly  from  the  conclusions  of  Sir  William 
Hamilton,  Dr.  Sims,  and  Dr.  Clendenning.  Sir  W.  Hamilton  estimated 
the  weight  of  the  adult  male  encephalon  at  3  Ib.  8  oz.  troy,  and  the 
female  at  3  Ib.  4  oz.,  which  are  nearly  48  oz.  5  dr.,  and  43  oz.  15  dr. 
avoirdupois.  On  calculating  the  weights  of  the  brain  in  the  two  sexes 
separately,  from  the  observations  published  by  Dr.  Sirns,  I  find  the  male 
brain,  in  54  persons  between  20  and  60  years  of  age,  to  average  47  oz. 
13  dr.,  and  the  female  brain  in  58  persons,  44  oz.  and  10  dr.  Dr.  Clen- 
denning states  the  male  brain  in  persons  between  21  and  60  years  of  age 
to  average  45'85  oz.,  and  the  female  41'25  oz.  These  several  averages, 
together  with  those  deduced  by  Professor  Reid  and  myself,  range  be- 
tween 45f  oz.  and  50J  oz.  for  the  male,  and  41 J  oz.  and  nearly  45  oz. 
for  the  female. 

44  Tiedemann,*  whose  actual  observations  amount  to  only  52  (35  males 
and  17  females),  states  the  weight  of  the  adult  European  encephalon  to 
vary  in  the  male  between  3  Ib.  2  oz.  and  4  Ib.  6  oz,  troy,  or  41  oz.  12 
dr.  and  59  oz.  5  dr.  avoirdupois,  and  in  the  female,  between  2  Ib.  8  oz. 
and  3  Ib.  11  oz.  troy,  or  35  oz.  2  dr.  and  51  oz.  11  dr.  avoirdupois. 

44  The  want  of  accurate  information,  as  to  the  number  of  observations 
on  which  their  calculations  are  based,  of  the  weights  employed,  and  of 
the  ages  of  the  persons,  render  the  statements  of  the  older  anatomists, 
as  to  the  weight  of  the  encephalon,  of  little  value.  Soemmerring  states — 
4  Cerebrum  et  cerebellum,  resecta  medulla  spinali  statim  pone  nervum 
lingualem  medium  pondo  sunt  librarum  duarurn  ad  tres  libras ;  sunt 
enim  alia  cerebra  pondere  librarum  duarum  et  unciarum  quinque  cum 
dimidia,  alia'librarum  trium  et  unciarum  trium  cumtribus  quartis.  Aliis 
(referring  to  the  weights  of  brain  assigned  by  Haller,  Elementa  Physio- 

*  Phil.  Trans.,  vol.  cxxvii.  p.  497. 


152  HUMAN   BRAIN. 

logiae,  t.  iv.,  p.  10)  observala  sunt  cerebra  librae  unius  cum  dimidia,  aliis 
pondus  librarum  quinque  superantia,  quod  posterius  vero  baud  verisimile 
videtur,  nisi  forte  diverse  hexagio  res  rite  iriterpretari  possit.'  (De  cor- 
poris  humani  fabrica,  t.  iv.,  f.  38.)  He  adds,  in  a  note,  'In  universum 
quidem  Hallerus  cerebrum  pondere  esse  librarum  quinque  autumat, 
rectius  certe  quatuor,  si  de  pondere  pharmaceutico  Germanico  sermo  est. 
Certe  enim  inter  plura  quam  ducenta  cerebra  a  me  disquisita  nullum 
inveni  quod  quatuor  sit  librarum.'  From  this  it  appears  that  Soemmer- 
ring  employed  the  German  or  Nuremberg  pound  of  5524*8  grains,  and 
the  weights  which  he  gives  consequently  vary  between  31  oz.  and  41 
oz.  and  14  dr.  avoirdupois,  much  below  the  estimates  of  more  recent 
observers  ;  but  as  he  imagined  the  brain  to  attain  its  full  development 
at  3  years  of  age,  and  has  not  specified  that  the  weights  referred  to  were 
those  only  of  adults,  we  may  infer  that  he  included  in  his  calculation 
the  brains  of  persons  in  early  life.  The  estimate  of  the  Wenzels  seems 
more  nearly  correct: — 'Pondus  encephali  humani,  quale  id  de  quinto 
vitse  anno  ad  summam  usque  hominis  senectutem  plerumque  invenitur, 
pondus  viginti  quatuor  millium  granorum  non  superat.  *  *  *  Totius 
cerebri  pondus  inter  viginti  et  viginti  duo  millia;  cerebri  strictius  dicti 
inter  octodecern  et  viginti  millia  granorum  plerumque  variat.' — (De 
penitiori  structura  Cerebri  Hominus  et  Brutorum,  f.  267.)  The  weight 
of  the  encephalon  thus  given,  is  from  45  oz.  12  dr.  to  50  oz.  5  dr. 
avoirdupois;  and,  as  including  persons  in  early  and  advanced  life,  and 
of  both  sexes,  is  sufficiently  exact.  The  weight  of  the  encephalon  is 
estimated  by  Portal  at  48  oz.  3J  dr.  avoirdupois;  and  by  Meckel,  if 
his  weight  be  the  German  lb.,  at  43  oz.  and  11  dr.  avoirdupois.  M. 
Lelut*  estimates  the  weight  of  the  encephalon  of  the  male  adult  at  1320 
grammes,  or  46  oz.  10  dr.  avoirdupois ;  and  M.  Parchappef  at  1323 
grammes,  or  46  oz.  11  dr.;  and  that  of  the  female  at  1210  grammes, 
or  42  oz.  11  dr.  avoirdupois. 

U2d.  The  human  encephalon  appears  ordinarily  to  attain  its  maximum 
of  development  at  from  the  20th  to  the  25th  year ;  throughout  the 
middle  period  of  life  it  displays  little  variation,  but  a  very  marked  de- 
crease in  weight  obtains  in  advanced  age.  This  conclusion  is  uniformly 
borne  out  by  the  weights  of  the  encephalon  at  different  ages  in  both 
sexes ;  nor  do  the  tables  afford  any  support  to  the  opinions  of  Soemmerring, 
the  Wenzels,  and  Sir  W.  Hamilton,  that  the  brain  arrives  at  perfection 
in  or  before  the  7th  year.  Though  it  may  occasionally  happen  that  the 
brain  of  a  person  in  early  life  shall  be  found  as  heavy  as  are  ordinarily 
the  brains  of  adults,  yet  the  average  of  the  weights  of  several  brains 
between  10  and  20  years  of  age,  is  uniformly  less  than  that  afforded  by 
the  brains  of  persons  between  25  and  55  years  of  age4 

"Note. — The  gradual  increase  in  the  weight  of  the  encephalon  up  to 
adult  age,  accords  with  the  conclusions  of  Dr.  Sims,  and  with  the  views 

*  Gazette  Medicale  de  Paris,  2™  serie,  t.  v.,  1837,  p.  146. 

t  Ibid.  See  also  M.  Parchappe's  Memoir,  t.  x.  1842,  p.  650,  where  he  gives  the  weight 
of  the  encephalon  in  males,  1352  grammes;  and  in  females,  1229. 

J  These  results  accord  with  Dr.  Reid's  previous  inferences.  The  decrease  in  the  weight 
of  the  encephalon  in  advanced  life,  is,  it  will  be  observed,  much  more  marked  in  females 
than  in  males. 


WEIGHT   OF   THE   BRAIN.  153 

of  Gall  and  Spurzheim.  Soemmerring,  however,  from  one  observation, 
inferred  that  the  brain  attained  its  full  weight  at  three  years  of  age,  and 
the  Wenzels  at  7.  The  latter  age  has  also  been  regarded  by  Sir  W. 
Hamilton  as  the  probable  term  of  growth  of  the  brain.  The  present 
observations  further  confirm  the  inference,  that,  contrary  to  the  supposi- 
tion of  the  Wenzels  and  Sir  W.  Hamilton,  the  encephalon  decreases  in 
weight  in  advanced  life.  In  reference  to  Sir  W.  Hamilton's  observa- 
tions, it  may  be  remarked  that  the  actual  weights  of  human  brains  can 
alone  form  just  data  for  conclusions;  and  that  it  seems  scarcely  possible 
that  any  method  of  ascertaining  the  size  of  the  brain  from  examination 
of  the  skull  can  be  free  from  fallacy* — an  objection  especially  applicable 
to  estimates  so  formed  of  the  weight  of  the  brain  in  advanced  age,  when, 
as  is  well  known,  the  ventricular  cavities  and  subarachnoidal  cellular 
tissue  often  contain  much  fluid. 

"  3d.  The  excess  of  weight  of  the  male  over  the  female  encephalon, 
is  observed  at  an  early  age,  and  continues  throughout  the  course  of  life. 
This  inference  is  applicable  after  the  commencement  of  the  second  year  ; 
before  that  period  the  data  are  too  imperfect  to  allow  of  any  conclusions 
being  founded  upon  them. 

"4th.  The  average  weight  of  the  cerebrum  in  adult  males,  is  44  oz. 
3-4  dr.,  and  in  females,  39  oz.  3'3  dr. ;  the  cerebrum  of  the  male,  there- 
fore, exceeds  in  weight  that  of  the  female  by  5  oz.  0-1  dr. 

"  5th.  The  cerebellum,  with  the  pons  Varolii,  and  medulla  oblongata, 
averages  in  adult  males,  6  oz.  40-5  dr.;  in  females,  5  oz.  10  5  dr. — the 
excess  in  the  male  being  9-55  dr. 

"  6th.  The  cerebellum  alone,  calculated  from  Professor  Reid's  obser- 
vations, averages  in  the  adult  male  5  oz.  2-6  dr.,  and  in  the  female  4 
oz.  12-4  dr. — the  difference  being  6*2  dr. 

"  7th.  It  has  been  seen  that  the  encephalon  may  be  regarded  as  at- 
taining its  maximum  of  development  at  from  the  20th  to  the  25th  year, 
and  declines  in  weight  in  advanced  life.  The  same  law  obtains  in  re- 
ference to  the  development  and  decline  of  its  several  portions.  It  would, 
however,  appear  probable  that  the  cerebellum,  with  the  pons  Varolii  and 
medulla  oblongata,  arrive  at  their  full  growth  somewhat  earlier  than  the 
cerebral  hemispheres.  This  surmise  is  supported  by  the  weights  of  the 
former  portions  of  the  brain  between  10  and  20  years  of  age,  exceeding 
in  females  their  weight  in  the  adult,  and  being  in  males  very  slightly  less 
than  their  weight  in  the  adult.  The  results  given  in  the  tables  are,  how- 
ever, unfavorable  to  the  idea  of  Sir  W.  Hamilton,  that  the  cerebellum 
attains  its  maximum  of  development  at  about  the  7th  year — an  opinion 
opposed  also  by  the  weights  of  the  cerebellum  alone,  as  given  by  Pro- 
fessor Reid. 

"  8th.  The  excess  which  obtains  in  the  weight  of  the  encephalon  of 
the  male  over  that  of  the  female,  exists  also  in  each  of  the  several  por- 
tions of  the  brain — the  cerebrum,  the  cerebellum,  with  the  pons  Varolii 
and  medulla  oblongata,  and  the  cerebellum  alone,  being  uniformly  heavier 

*  Sir  W.  Hamilton  states  his  observations  to  have  been  founded  "on  inductions  from 
above  60  human  brains,  and  from  nearly  300  human  skulls  of  determined  sex,  the  capacity 
of  which,  by  a  method  I  devised,  was  taken  in  sand,  and  the  original  weights  of  the  brain 
thus  recovered.'' — Monro's  Anatomy  of  the  Erain,  1831. 


154  HUMAN    BRAIN. 

in  the  male  than  in  the  female.  The  excess  in  the  weight  of  each  of 
these  portions  of  the  brain  in  the  male  over  their  weight  in  the  female, 
maintains  a  very  similar  ratio,  a  fact  opposed  to  the  conclusion  of  Sir 
W.  Hamilton,  'that  almost  the  whole  difference  in  the  weight  of  the 
male  and  female  encephali  lies  in  the  brain  proper,  the  cerebella  of  the 
two  sexes  absolutely  being  nearly  equal ;  the  preponderance  being  rather 
in  favor  of  the  female.' 

"  9th.  The  relative  proportion  of  the  encephalon  to  the  whole  body 
undergoes  a  gradual  decrease  from  infancy  to  adult  age  ;  and  averages 
in  males,  at  from  25  to  55  years  of  age,  I  to  37-2,  presenting  during  this 
period  a  range  of  from  1  to  79-98  to  1  to  25-2,  according  to  the  state  of 
emaciation  or  corpulence  of  the  body  weighed. 

"  In  females  the  average  during  adult  life  is  1  to  33'5,  and  the  extremes 
1  to  44-8  and  1  to  24-1.  It  will  be  seen  that,  as  before  remarked  by 
the  Wenzels  and  Tiedemann,  the  female  brain,  though  absolutely  lighter 
than  that  of  the  male,  maintains  a  higher  proportion  relatively  to  the 
weight  of  the  body. 

"  10th.  The  proportions,  relatively  to  the  whole  body,  of  the  cere- 
bellum with  the  pons  Varolii  and  medulla  oblongata,  and  of  the  cerebellum 
alone  (as  shown  by  Dr.  Reid's  observations),  also  gradually  decreases 
from  infancy,  and  at  adult  age  the  former  averaged  in  males  1  to  277' 1, 
presenting  the  extremes  of  1  to  424-7  and  1  to  244-5. 

"The  proportion  in  adult  females  is  1  to  290-7,  and  the  extremes  1 
to  326-  and  1  to  213-3. 

"  Tiedemann  found  the  relative  proportion  of  the  encephalon  to  the 
body  in  adults  as  1  to  35  and  1  to  45,  and  the  extremes  1  to  22  and  1  to 
50  to  100. 

"llth.  The  proportion  which,  in  the  adult,  the  cerebellum  with  the 
pons  Varolii  and  medulla  oblongata  bear  to  the  whole  encephalon,  is  1  to 
7-8,  and  is  nearly  the  same  in  the  two  sexes,  being  as  1  to  8-057  in  the 
male,  and  1  to  7-87  in  the  female. 

"  Dr.  Reid  had  been  led  to  infer  that  the  cerebellum  with  the  pons 
Varolii  and  medulla  oblongata  was  relatively  to  the  encephalon  heavier, 
in  a  somewhat  higher  proportion,  in  the  female  than  in  the  male,  being 
as  1  to  7-9  and  1  to  8-6  respectively.  His  calculations  are,  however, 
founded  on  the  weights  of  53  male  and  34  female  brains,  while  the  present 
tables  include  96  and  58  weights.  From  my  own  observations  separately, 
the  proportions  are  as  1  to  7-98  in  females,  and  1  to  7-93  in  males. 

"  12th.  The  ratio  of  the  weight  of  the  cerebellum  alone  to  that  of  the 
whole  encephalon,  is,  in  the  male,  between  25  and  55  years  of  age,  1  to 
9-58,  and  in  the  female  1  to  9-34. 

"  13th.  The  relative  proportion  of  the  cerebellum  to  the  cerebrum  in 
adults  of  the  two  sexes,  as  calculated  from  Dr.  Reid's  data,  is  in  males 
1  to  8-37;  in  females  1  to  8'28.  Sir  W.  Hamilton  states, 'that  the 
cerebellum  in  the  female  is  in  general  considerably  larger  in  proportion 
to  the  brain  proper  than  in  the  male;  in  the  female  it  is  as  1  to  7-6,  in 
the  male  as  1  to  8*4.'  The  calculations  now  given  show  the  weights  of 
the  cerebellum  with  the  pons  Varolii  and  medulla  oblongata,  and  of  the 
cerebellum  alone,  to  be,  relatively  to  that  of  the  whole  encephalon, 
somewhat  higher  in  females  than  in  males.  This  inference  is  not, 


WEIGHT    OF    THE    BRAIN.  155 

however,  confirmed  by  the  observations  of  M.  Parcbappe  ;  and  the  dif- 
ference which,  from  the  present  data,  appears  to  exist,  is  much  less  than 
was  supposed  by  Sir  W.  Hamilton.  It  is,  therefore,  very  questionable 
how  far  the  excess  of  weight  in  females  can  be  regarded  as  constituting 
a  general  rule. 

"  14th.  Though  the  data  now  published  are  defective  in  weights  of 
the  whole  encephalon  and  its  several  portions,  in  infants  and  young  per- 
sons, they  render  it  most  probable  that  the  ratio  of  the  cerebellum  alone 
or  with  the  pons  Varolii  and  medulla  oblongata,  to  the  cerebrum  and 
encephalon,  undergoes  but  little  change  during  the^whole  period  of  life, 
after  the  expiration  of  the  first  year.  Further  observations  are  required 
on  this  point ; — the  facts  at  present  recorded  are,  however,  opposed  to 
the  surmise,  that  the  cerebellum  attains  its  complete  state  of  develop- 
ment at  a  period  much  anterior  to  that  of  the  rest  of  the  brain." 


156 


PART   V. 

-    ,f^  j 

CONFIGURATION  OF  THE  ENCEPHALON. 

BEFORE  the  student  begins  to  trace  the  medullary  fibres  of  the  cere- 
bro-spinal  axis,  in  order  to  ascertain  the  connections  and  relations  of  one 
part  with  another,  as  well  as  those  of  the  cineritious  with  the  medul- 
lary neurine,  it  will  be  desirable  to  take  a  general  view  of  the  external 
form  and  appearance  of  the  entire  brain  and  spinal  cord.  He  will  thus 
become  acquainted  with  the  different  elevations  and  depressions  observ- 
able on  its  surface.  Our  predecessors,  till  lately,  confined  their  attention 
almost  entirely  to  external  appearances,  and  to  such  as  are  produced  by 
section,  and  obtained  but  an  imperfect  idea  of  the  real  structure  of  the 
organ;  but  we  must  not  fall  into  the  opposite  error,  and  neglect  the 
observation  of  outward  form  as  wholly  unnecessary  or  unphilosophical. 
We  must  only  be  on  our  guard  at  the  same  time  not  to  confound  the 
i  study  of  mere  outward  configuration  with  a  knowledge  of  internal 
structure. 

In  studying  the  configuration  of  the  cerebral  mass,  we  shall  find  it 
advantageous  to  divide  its  surface  into  two  portions,  the  one  external 
and  convoluted,  the  other  internal,  which  presents  appearances  of  so 
precise  a  form  that  it  may  be  called  the  Jigurate;  the  convoluted,  as 
will  be  explained  afterwards,  forming  a  sort  of  envelop  or  wrapper  to 
the  figurate. 

The  relative  positions  of  the  different  portions  of  the  brain  within  the 
human  skull  are  well  seen  by  making  a  perpendicular  section  of  the 
skull  and  brain  from  before  to  behind.  Fig.  71  represents  such  a  section ; 
and  although  the  student  is  not  supposed  to  be  acquainted  with  all  the 
ganglia  shown  in  this  drawing,  it  will  be  found  instructive  to  study  it 
generally,  and  refer  to  it  again  hereafter. 

After  removing  the  brain  and  spinal  cord  from  the  skull  and  vertebral 
canal,  by  dividing  the  nerves  as  they  pass  through  their  appropriate  fora- 
mina, the  student  should  place  the  brain  upon  its  upper  surface,  which 
will  expose  what  is  usually  called  the  base  of  the  brain  (fig.  72),  and  the 
anterior  surface  of  the  spinal  cord.  By  the  term  spinal  cord  we  mean 
all  that  portion  of  the  cerebro-spinal  axis  which  is  contained  within  the 
vertebral  canal,  and  which,  it  will  be  seen,  occupies  the  whole  of  the 
cervical  and  dorsal  regions;  but  in  the  sacral  and  (he  lower  portion  of 
the  lumbar,  its  place  in  the  canal  is  occupied  by  the  nerves  supplying 
the  lower  part  of  the  trunk  and  the  inferior  extremities.  The  appear- 
ance produced  by  the  collection  of  the  large  nerves  in  the  interior  of  the 
canal,  from  its  resemblance  to  a  horse's  tail,  is  called  the  cauda  equina 


SPINAL    CORD. 


157 


(see  fig.  81).  The  size  of  the  cord  varies:  in  the  cervical  region  it  is 
widest,  and  in  the  middle  of  the  dorsal  narrowest,  widening  again  at 
the  lower  part  of  the  dorsal,  and  then  gradually  tapering  off  to  a  point 
opposite  the  second  lumbar  vertebra,  where  it  appears  to  terminate  in  a 

Fig.  71. 


Side  view  of  a  mesial  section  of  the  human  skull,  nasal,  oral,  and  laryngeal  cavities,  the  vertebral 
caiial  and  brain.  B.  Hemispherical  ganglion,  or  convoluted  surface  of  the  brain.  E.  Cerebellum, 
showing  the  arbor  vitse.  F  M.  Falx  major  of  the  dura  mater.  J.  This  letter  is  placed  on  the  sphenoid 
bone,  just  in  front  of  the  sella  turcica  and  pituitary  gland.  From  this  body,  which  is  represented  as  a 
white  rounded  knot,  there  is  a  white  tubular-looking  body,  extending  up  to  the  brain — the  infundibulum  ; 
this  is  large.  The  rounded  body  behind,  is  the  corpus  mammillare.  H.  Spinal  cord.  K  Thalamus  nervi 
optici ;  above  the  letter  is  the  commissura  mollis.  N.  Septum  lucidum,  which  conceals  the  corpus  stria- 
turn;  the  white  line  behind  the  letter  is  the  anterior  pillar  of  fornix.  p.  Corpus  callosum.  x.  Pons 
Varolii. 

single  nerve,  the  ligamentum  filiforme,  just  described.  Anatomists  have 
rather  differed  in  opinion  as  to  the  exact  limits  of  the  cord  superiorly  : 
physiologically  speaking,  it  extends  to  the  hemispheres  ;  but  guided  by 
its  external  configuration  we  may  describe  its  superior  boundary  as 
formed  by  the  corpus  olivare,  with  which  the  medulla  oblongata  com- 
mences. After  passing  through  the  foramen  magnum  into  the  skull,  the 
spinal  cord  becomes  very  much  enlarged,  and  changes  its  name  to  that 
of  the  medulla  oblongata  (figs.  72,  85).  At  the  upper  edge  of  the  me- 
dulla oblongata  a  large  knot  or  thick  band  of  medullary  fibres  of  about 
an  inch  in  width  will  be  observed  passing  over  and  bounding  it ;  this 
structure  is  the  commissure  of  the  cerebellum,  or  pons  Varolii  (x).  The 
cerebellum  (E),  or  little  brain,  is  the  oval-shaped  body,  to  which  this 
structured  is  attached  laterally,  and  which  lies  beneath  the  tentoriuin 
when  in  its  normal  situation  in  the  skull  (see  fig.  71). 

At  the  upper  edge  of  the  commissure  of  the   cerebellum  we  observe 
two  rounded  bands,  about  half  an  inch  in  thickness,  emerging  from  be- 


158 


HUMAN   BRAIN. 


hind  the  commissure,  and  spreading  as  they  pass  forwards  and  outwards 
to  be  lost  beneath  the  convolutions  of  the  hemispheres  ;  these  are  called 
the  crura  cerebri  (u  u,  fig.  72).  At  the  point  where  the  crura  are  first 
covered  by  the  convolutions,  we  observe  on  either  side  a  thin  band  of 
medullary  neurine,  about  three  lines  in  width,  crossing  them  ;  these  two 
bands  gradually  approach  each  other,  and,  apparently  joining,  form  what 
is  called  the  commissure  of  the  optic  nerves ;  the  bands  themselves  go  by 
the  name  of  the  tractus  optici.  The  line  from  e  crosses  this  band  on  the 
left  side.  A  space  is  thus  left  between  the  divergence  of  the  crura  cere- 
bri and  the  convergence  of  the  tractus  optici,  of  a  diamond  shape,  within 
which  we  observe  two  white  rounded  bodies,  called,  from  their  appear- 
ance, the  corpora  mammillaria  seu  albicantia  (c),  anterior  to  which  bo- 
dies, and  partly  surrounding  them,  we  observe  a  layer  of  cineritious 
neurine,  the  tuber  cinereum  or  pons  Tarini  («),  in  the  centre  of  which  is 
a  funnel-shaped  body,  the  infundibulum,  or  pituitary  process,  by  which 
it  is  attached  to  the  pituitary  gland  (see  fig.  71,  j). 

Fig.  72. 


Base  of  the  human  brain.  A  portion  of  the  middle  lobe  on  the  left  side  has  been  removed  to  show  the 
tractus  opticus  and  crus  cerebri.  a r.  Three  roots  of  olfactory  nerve,  b.  Ojmc  aerve.  Iq.  Locus  quacl- 
ratas.  e.  Corpora  albicantia;  the  white,  funnel-like  body  in  front  of  these  is  the  infundibulum.  a.  Tuber 
cinereum.  c.  Third  pair  of  nerves,  d.  Fourth  ditto,  e.  Fifth  ditto.  /.  Sixth  ditto,  g.  Seventh  ditto, 
facial,  h.  Eighth  ditto,  auditory,  i.  Ninth  ditto,  glosso-pharyngeal.  j.  Tenth  ditto,  pneumogastric.  k. 
Eleventh  ditto,  lingual.  L.  Twelfth  ditto,  spinal  accessory.  A.  Olfactory  ganglion.  B.  Hemispherical 
ditto.  D.  Orbitar  convolution.  E.  Cerebellum.  H.  Spinal  cord.  s.  Olivary  body.  T.  Pyramidal  ditto. 
u.  Crus  cerebri.  x.  Pons  Varolii.  at.  Anterior  lobe.  ml.  Middle  lobe.  pi.  Posterior  lobe.  FS.  Fis- 
sui-a  Sylvii. 

Behind  the  corpora  mammillaria  is  a  layer  of  medullary  neurine,  called 
the  substantia  perforata  posterior,  from  its  being  perforated  for  the  pas- 
sage of  vessels,  and  posterior  to  another  similar  spot  ;  it  cannot  be  seen 
in  this  figure.  On  either  side  of  the  diamond-shaped  space  described, 


BASE   OF   THE    BRAIN.  159 

we  observe  the  mass  of  convoluted  cineritious  neurine,  denominated  the 
hemispheres  of  the  brain.  These  are  considered  as  divided  into  three 
lobes  on  each  side  ;  the  division  between  the  anterior  lobe  (a  1}  and  the 
middle  lobe  (m  1)  is  well  marked  by  a  fissure,  called  the  fissura  Sylvii 
(F  s),  which  corresponds  to  the  lesser  wings  of  the  sphenoid  bone.  This 
fissure  may  be  traced  to  the  outer  surface  of  the  jiemispheres,  where  its 
depth  is  considerable.  The  fissura  Sylvii  commences  near  the  mesial 
line,  under  the  tractus  opticus,  in  a  broad,  quadrilateral,  perforated 
space,  to  which  the  student  will  be  frequently  directed  in  the  description 
of  the  convolutions.  This  spot  is  called  the  locus  perforates  anterior,  or 
locus  quadrilateralis  (lq).  The  division  between  the  middle  and  poste- 
rior lobe  (p  I)  is  more  arbitrary,  and  corresponds  to  the  superior  angle 
of  the  petrous  portion  of  the  temporal  bone  in  the  interior  of  the  skull. 

The  description  of  the  arteries,  though  seen  in  this  view  of  the  brain, 
will  be  given  after  the  whole  account  of  the  configuration  and  dissection 
of  the  brain  is  completed. 

The  different  pairs  of  cerebral  nerves  may  also  be  seen  in  this  view, 
but  as  their  exact  connections  will  be  minutely  described  after  the  student 
has  become  accurately  acquainted  with  the  real  structure  of  the  cerebral 
mass,  it  is  unnecessary  to  dwell  upon  them  now. 

The  dissector  may  now  reverse  th,e  position  of  the  brain  by  placing  it 
upon  the  base  :  he  will  then  observe  the  upper  surface  of  the  hemispheres 
divided  by  a  deep  fissure,  into  which  the  falx  major  of  the  dura  mater 
passes  (fig.  71),  and  by  separating  the  hemispheres  he  will  perceive  at 
the  bottom  of  the  fissure  a  white  band  of  medullary  matter,  called  the 
great  commissure  of  the  cerebrum,  or  corpus  callosum  (fig.  77,  p). 

Let  us  next  direct  our  attention  to  the  convoluted  surface  of  the  brain, 
which  is  formed  by  the  folding  of  the  hemispherical  ganglion.  In  the 
following  account  I  shall  follow  Leuret  and  Foville;  though  I  cannot 
attempt  the  minuteness  of  this  latter  author,  who  devotes  forty  pages  to 
his  description. 

All  the  convolutions  may  be  said  to  spring  from  that  spot  at  the  base 
of  the  brain  which,  situated  in  the  fissura  Sylvii,  is  called  the  quadrila- 
teral spot,  or  substantia  perforata  anterior.  This  fact  is  interesting  when 
we  revert  to  the  development  of  the  hemispherical  ganglion  ;  whether  we 
trace  the  permanent  forms  it  assumes  in  the  various  genera  of  animals, 
or  in  its  transient  forms  during  the  evolution  of  the  human  embryo.  At 
this  spot  we  first  observe  this  ganglion  as  a  mere  point;  see  the  brain  of 
the  fish  (figs.  26,  29,  30,  31)  and  the  brain  of  the  embryo  of  nine  weeks: 
and  from  these  small  beginnings  it  gradually  assumes  its  enormous  size 
and  convoluted  form.  See  also  the  explanation  of  the  formation  of  the 
Ipteral  ventricles  (figs.  79  and  80). 

In  attempting  to  classify  the  convolutions  of  the  human  brain,  it  is  not 
pretended  that  they  will  be  found  alike  in  all  brains,  but  as  regards  their 
main  form  and  direction  there  is  considerable  uniformity.  The  variety 
will  be  found  not  so  much  in  the  longitudinal  foldings,  which  in  the 
human  brain  assume  a  crescentic  figure,  but  in  the  transverse  or  anasto- 
mosing foldings. 

The  convolutions  are  not  even  exactly  alike  on  both  sides  of  the  brain. 
Curiously  enough,  we  find  them  almost  in  exact  correspondence  in  the 


160 


HUMAN    BRAIN. 


brain  of  the  monkey  and  the  idiot,  and  even  in  some  of  the  lowest  of 
the  negroes. 

There  are  four  orders  of  convolutions.  The  first  order  of  convolutions 
contain  only  one  ;  this  is  seen  in  a  lateral  view  of  the  brain,  looking  from 
within  outwards,  after  a  section  has  been  made  through  the  mesial  (see 
fig.  72). 

It  may  be  describee  as  commencing  anteriorly  from  the  substantia 
perforata  anterior,  or  the  quadrilateral  perforated  spot — locus  perforatus 
quadrilateralis  ;  A  B  the  commencement  of  this  convolution,  and  D'  its 
termination.  It  will  be  seen  to  spring  from  the  base  of  the  brain  at  the 
posterior  extremity  of  the  anterior  lobe.  It  then  runs  upwards  and  turns 
(/)  round  the  corpus  callosum  (i),  runs  (b  b)  along  its  upper  surface,  winds 
down  behind  its  posterior  margin,  descends  to  the  base  of  the  brain,  ter- 
minating close  to  where  it  began,  namely,  at  the  opposite  border  of  the 
fissura  Sylvii,  and  therefore  without  crossing  it. 

Fig.  73. 


Internal  surface  of  the  left  hemisphere  of  the  brain.  The  great  transverse  commissure  divided  in  the 
mesial  line.  (Foville.)  c' T.  Corpus  callosum.  R.  Septum  lucidum.  v.  Anterior  pillar  of  the  fornix.  z. 
Anterior  commissure  divided.  T.  Convex  surface  of  the  optic  thalamus.  w.  Aquauductus  Sylvii.  s. 
Pineal  gland,  x.  Peduncle  of  pineal  gland.  N.  Section  of  crus  cerebri.  M.  Corpus  mammillare.  K'. 
Tuber  cinereum.  K.  Section  of  the  chiasma  of  the  optic  nerves.  L.  Optic  nerve,  i.  Olfactory  nerve. 
A.  Quadrilateral  perforated  space,  a.  Internal  part  of  the  quadrilateral  space,  where  the  septum  lucidum. 
is  united  to  it.  B,  bbb',  B',  D'.  Vertical  section  of  the  convolution  de  1'ourlet  (superior  longitudinal  com- 
missure). B.  Beginning  of  this  convolution.  D'.  Its  termination,  named  the  temporal  tuberosity.  B'. 
Crotchet  of  this  tuberosity.  D",  DDDDD,  dd,  D,D'".  First  convolution  of  the  second  order,  forming  the 
eccentric  circumference  of  the  internal  surface  of  the  hemisphere,  of  which  the  convolution  de  1'ourlet 
forms  the  concentric  circumference  D".  The  origin  of  the  great  convolution  of  the  second  order.  D'". 
Indicates  the  termination  of  this  convolution  in  the  summit  of  the  temporal  lobe.  cccc.  Convolutional 
branches. of  the  third  order  crossing  the  internal  surface  of  the  hemisphere,  uniting  the  convolution  de 
1'ourlet  to  the  great  convolution  of  the  second  order.  EE.  Branch  of  the  third  order,  uniting  the  convolu- 
tion de  1'ourlet  to  the  great  convolution  of  the  second  order  in  the  quadrilateral  group.  FF.  Branch  of  the 
third  order,  forming  the  peduncle  of  the  triangular  group,  extending  from  the  convolution  de  1'ourlet  to 
the  great  convolution  of  the  second  order.  G  Y.  Last  branch  of  the  third  order,  uniting  the  convolution 
de  1'ourlet  to  the  great  convolution  of  the  second  order  in  the  cerebello  temporal  zone  of  the  hemisphere. 
H.  Anfractuosity  of  the  internal  surface  running  up  to  the  eccentric  border  of  the  hemisphere.  H'.  An- 
fracluosity  of  the  same  kind,  forming  a  fissure  between  the  crossing  group  and  the  quadrilateral  group, 
p.  Fissure  posterior  to  the  quadrilateral  group. 


CONVOLUTIONS.  161 

In  following  this  convolution,  the  student  will  find  that  its  course  is 
exactly  similar  to  that  which  the  whole  hemispheres  take,  as  will  be  de- 
scribed in  my  explanation  of  the  formation  of  the  ventricles  of  the  brain 
(see  figs.  79  and  80,  p.  195).  This  convolution  contains  within  it  the 
superior  longitudinal  commissure,  and  marks  its  direction.  It  is  the 
hem  or  ourlet  of  Foville.  This  convolution  he  calls  le  cir convolution  de 
Vourlet. 

We  have  already  seen  this  as  one  of  the  primary  convolutions  of  the 
brain  of  the  fox. 

The  second  order  of  convolutions  comprehends  two.  They  arise,  like 
the  last,  from  the  quadrilateral  space  and  also  from  the  last  convolution, 
from  which  they  spring  like  buds  from  a  branch.  The  convolution  DD  D, 
p,  D,  d  dy  (fig.  73,)  forms  the  external  margin  of  the  circle  of  the  hemi- 
sphere, just  as  the  first  convolutions  form  the  internal  margin  of  the 
circle  ;  this  is  the  great  convolution.  It  may  be  said  to  run  from  the 
fissura  Sylvii  to  the  anterior  extremity  of  the  hemisphere,  and  then 
mounting  up,  forms  the  upper  part  of  the  hemisphere;  and  the  edge  of 
the  median  fissure  running  forwards  terminates  at  the  extremity  of  the 
temporal  lobe  (see  fig.  74,  N,  A,  D",  V  I,  D  G,  BG,  DG,  qq,  o  ;  fig.  76, 
aaaa  a',  D',  GG  G). 

In  the  brain  of  new-born  infants,  and  particularly  in  foetuses  of  seven 
months,  this  line  of  convolution  is  without  any  sinuosity.  In  this  re- 
spect it  resembles  the  simple  longitudinal  convolutions  of  the  lower  ani- 
mals. Its  complexity  is  occasioned  by  its  enormous  length,  requiring 
to  be  again  and  again  folded  transversely  to  get  it  into  its  allotted  space 
(see  figures  at  page  123). 

The  second  convolution  of  the  second  order  forms  the  circumference 
of  the  fissura  Sylvii  (see  fig.  74,  Y,  K,  i,  P  P,  p,  v,  E).  It  presents  in  its 
course  two  divisions,  which  again  subdivide  into  three.  The  first  forms 
the  anterior  lip  of  the  fissure  of  the  external  border  of  the  orbitar  triangle 
delineated  horizontally  ;  it  is  moderately  winding,  and  terminates  at  the 
junction  of  the  horizontal  orbitar  region  with  the  convex  vertical  region 
of  the  outer  part  of  the  frontal  lobe.  This  convolution  we  have  seen 
also  in  the  lower  animals  (see  figs.  60  and  64). 

This  convolution  in  man,  like  the  last-mentioned,  is  so  long,  that  in 
its  many  transverse  foldings  we  lose  sight  of  its  original  simplicity. 

The  convolutions  of  the  third  order  may  be  divided  into  two  sets  ;  the 
first  are  situated  without  exception  on  the  internal  surface  of  the  hemi- 
sphere, and  in  the  internal  portion  of  the  fissura  Sylvii.  They  form  a 
sort  of  anastomosis  between  the  convolutions  of  the  first  and  second 
order  (fig.  73,  cc  c,  E,  F,  G,  Y,  E  E,  FF).  These  vary  in  numbers  from 
five  up  to  eight;  Foville  says  they  never  exceed  nine.  These  numerous, 
tooth-like  processes  from  the  convolution  of  the  superior  longitudinal 
commissure  induced  Rolando  to  call  it  processo  cristato.  The  second  set 
are  within  the  fissura  Sylvii,  and  occupy  the  space  called  by  Reil  Insula. 

Few  of  those  who  dissect  the  human  brain  in  the  old  way  are  aware 
of  the  depth,  breadth,  and  riches,  if  I  may  so  express  it,  of  the  fissura 
Sylvii:  they  know  it  only  as  a  slight  fissure  at  the  base  of  the  brain, 
separating  the  anterior  and  middle  lobes.  But  those  who  remove  the 
pia  mater  from  the  brain  previous  to  immersing  it  in  alcohol  are  well 


162 


HUMAN    BRAIN. 


aware  that  this  fissure  extends  upwards  from  the  base  of  the  brain,  on 
the  side  of  it,  nearly  to  the  posterior  extremity  of  the  vertex. 

The  sides  of  this  fissure  are  not  smooth ;  and  as  if  every  chink  and 
cranny  should  be  occupied,  to  get  this  enormous  convoluted  ganglion 
into  the  skull,  the  whole  of  this  fissure  is  occupied  with  a  distinct  set  of 
convolutions.  These  are  pyramidal  in  form,  with  their  apices  towards 
the  fissure,  and  their  bases  radiating  outwards,  as  to  a  circumference  of 
a  circle.  They  may  be  partly  seen  in  fig.  74  (c  c  c) ;  but  better  seen  in. 
fig.  75  (c  c  c  c). 

Convolutions  of  the  Fourth  Order. — The  distinctive  character  of  the 
convolutions  of  the  fourth  order  is,  that  they  have  no  direct  connection 
with  the  convolutions  of  the  first  order,  that  they  are  employed  to  fill  the 
space  left  between  the  two  great  lines  of  the  second  order. 

Fig.  74. 


This  figure  represents  the  external  surface  of  a  cerebral  hemisphere.  (Fqville  )  This  hemisphere  is 
remarkable  for  the  rich  development  of  its  convolutions.  E',  y,  K,  i,  p,  v,  E,  indicate  the  convolution  en- 
circling the  fissura  Sylvii — second  convolution  of  the  second  order,  c,  c,  c.  The  convolutionary  folds 
of  the  rnsula  seen  between  the  lips  of  this  fissure,  which  are  slightly  separated,  x,  N,  A,  D",  I'l,  D,  G,  B,  D', 
p,  G,  q  g,  o',  indicate  the  great  convolution  encircling  the  hemisphere — first  convolution  of  the  second 
order.  All  the  convolutions  on  the  convexity  of  the  hemisphere  run  from  the  convolution  around  the 
fissura  Sylvii  to  that  convolution  which  encircles  the  hemisphere.  The  convolutions  which  join  the 
second  with  the  first  convolution  belong  to  the  fourth  order.  Independently  of  their  connection  with  the 
two  convolutions  of  the  second  order  they  anastomose  sometimes  together,  Y,  t",  H,  A.  Transverse 
supraciliary  convolution  running  from  the  anterior  angle  of  the  fissura  Sylvii  to  the  internal  part  of  the 
posterior  extremity  of  the  hemispheres,  i,  i.  Transverse  medio-parietal  convolution  extending  from  the 
second  curve  of  the  convolution  around  the  fissure  of  Sylvius  to  the  twist  in  the  great  convolution  of  the 
second  order,  corresponding  to  the  anfractuosity  which  on  the  internal  surface  of  the  hemisphere  sepa- 
rates those  crossing  from  the  quadrilateral  group.  P,  P,  P,  p'.  Transverse  occipital  convolution  extending 
from  the  sharp  angle  of  the  fissure  of  Sylvius  to  the  posterior  extremity  of  the  hemisphere.  K,  K,  K.  An- 
terior transverse  parietal  convolution  situated  immediately  in  front  of  the  transverse  medio-parietal. 
s,  s,  1,1'.  A  branch  extending  anterior  from  K,  K,  K,  and  anastomosing,  a,  /,  /',  with  the  great  convolu- 
tionary band — first  convolution  of  the  second  order.  L',  s',  I'1.  A  branch  which,  running  from  K,  K,  K, 
anastomose  with  the  transverse  supra-ciliary  convolution.  +,  A  small  branch  joining  the  two  above- 
named  branches.  B,  R.  Posterior  transverse  parietal,  o,  o,  o.  Short  convolutions  uniting  the  extremity 
of  the  second  convolution  of  the  second  order  to  G,  q  q,  o'— the  last  portion  of  the  great  convolution  of  the 
second  order. 

In  order  to  understand  these  convolutions  it  is  necessary  to  consider 
them  as  prolongations  of  the  convolutions  of  the  third  order,  below  the 
two  convolutions  of  the  second  order  (see  figs.  74  and  76,  N  N,  1 1,  K  K, 


CONVOLUTIONS. 


L  L)  ;  and  in  fig.  76,  running  directly  across  the  upper  surface  of  the 
brain  (i  i),  also  K,  which  is  more  irregular  and  uncertain  than  the  last. 

Fig.  75. 


This  figure  represents  the  external  surface  of  the  cerebrum,  the  central  part  of  which  is  covered  by 
the  irisula.  (Foville.)  j.  Lower  part  of  the  fissura  Sylvii.  c,  c,  c;  c,  c,  c.  Insula.  B,  B,  B,  B.  Direction  of 
the  great  layer  of  converging  fibres  of  the  hemisphere,  a,  A,  A.J,j,  A,  A,  b.  Layer  of  eccentric  fibres  of 
the  lateral  surface  of  the  cerebrum,  a.  Temporal  tuberosity  of  the  convolution  de  1'ourlet.  D.  Cut  end 
of  a  bend  in  the  convolution  around  the  fissure  of  Sylvius. 

The  first  region  in  which  these  are  found  is  the  orbitar  triangle,  at  the 
base  of  the  brain  (see  fig.  74,  E  H). 

The  second  is  the  great  convex  space  bounded  before  by  the  anterior 
border  of  the  above  Triangle  (see  fig.  74,  I",  HA),  and  behind  by  a  line 
extending  from  the  posterior  angle  of  the  fissure  of  Sylvius  to  the  pos- 
terior point  of  the  hemisphere  (see  fig.  74,  p,  P,  P,  D'). 

Lastly,  the  third  region,  also  slightly  convex,  extends  from  this  line 
to  the  extremity  of  the  temporal  lobe  (see  fig.  74,  D',  v,  o'). 

This  fourth  order  is  especially  characteristic  of  the  human  brain,  from 
their  transverse  direction,  and  their  being  supplementary  to  the  longitu- 
dinal foldings. 

Fig.  76. 


CL' 


Superior  surface  of  the  left  cerebral  hemisphere.  D.  Anterior  extremity.  D'.  Posterior  extremity.  », 
o,  o,  a'.  Superior  segment  or  middle  of  the  great  convolution  of  the  second  order,  e,  i,  G'.  Small  frag- 
ment of  the  convolution  which  encircles  the  fissura  Sylvii — second  convolution  of  the  second  order.  i,"t. 
Transverse  medio-parietal  convolution.  D,  H,  A,  h.  Transverse  supraciliary  convolution.  G,  G,  G.  Trans- 
verse occipital.  All  these  transverse  convolutions  come  from  the  encircling  convolution  of  the  fissura 
Sylvii  to  the  great  convolution  of  the  second  order.  K.  Anterior  incomplete  transverse  convolution,  s. 
Posterior.  /,/',/".  Simple  convolutional  line  ou  the  side  of  the  fissure  divided  by  its  course  from  with- 
out to  within,  and  joining  by  its  branch  F',  the  great  convolution  of  the  second  order;  and  by  its  branch 
K",  the  transverse  supraciliary  convolution,  g,  g.  Line  of  union  of  the  transverse  occipital  convolution 
to  the  great  convolution  of  the  second  order.  This  cerebral  hemisphere  has  been  figured  as  an  example 
of  moderate  development  of  the  convolutions  on  the  convexity  of  the  brain. — (Foville.) 


164 


HUMAN   BRAIN. 


Figurate  Surface  of  the  Brain. — To  study  this  surface,  the  student 
should  now  make  a  section  with  a  large  knife,  of  one  of  the  hemispheres 
of  the  brain,  on  a  level  with  the  corpus  callosum,  (say  the  right  hemi- 
sphere,) cutting  from  the  mesial  fissure  horizontally  outwards:  theipor- 
tion  removed  must  not  be  thrown  away.  This  section  exhibits  what  is 
called  the  centrum  ovale,  and  exhibits  the  disposition  of  cineritious  and 
medullary  neurine  in  this  portion  of  the  brain.  The  cineritious  forms  a 
sort  of  bark  round  the  white  substance  ;  and  hence  it  has  been  called 
the  cortical  substance  of  the  brain  (see  fig.  77,  B  B  B  B).  This  cortical 
substance  is,  in  fact,  the  hemispherical  ganglion,  the  analogue  of  which 
the  student  will  remember  as  a  mere  rounded  point  in  the  fish,  in  man 
enormously  developed. 

Fig.  77. 


View  of  the  lateral  ventricles  of  the  brain.  A  section  has  been  made  of  the  hemispheres  of  the  brain 
on  a  level  with  the  great  transverse  commissure,  showing  the  centrum  ovale.  The  great  transverse 
commissure,  PP,  has  been  left  in  the  mesial  line,  and  extending  a  little  on  the  right  side.  On  this  side  the 
centre  of  the  lateral  ventricle,  LV,  is  opened  and  the  anterior  cornu,  ac.  On  the  left  side,  the  posterior 
cornu,  PV,  and  the  commencement  of  the  descending  cornu,  efe,  are  also  exposed.  In  the  body  of  the 
lateral  ventricle,  on  the  left  side,  may  be  seen  on  the  outside  the  corpus  striatum,  MM;  next  to  it,  taenia 
semicircularis,  t<r,  partly  covering  the  veni  Galeni,  vg;  next  to  this  is  the  thalamus  nervi  optici,  K,  from 
the  surface  of  which  the  plexus  choroides  has  been  removed,  but  still  partly  covered  by  the  central  por- 
tion or  body  of  the  fornix,  N.  A  piece  of  flat  black  whalebone  runs  under  the  fornix  from  one  ventricle 
into  the  other,  occupying  the  natural  position  of  the  plexus  choroides ;  on  the  right  side  the  ventricle  is 
partially  covered  by  the  corpus  callosum,  and  the  body  of  the  fornix  is  concealed,  but  the  plexus  cho- 
roides, pc,  has  been  left.  The  vena  Galeni,  vg,  is  uncovered  by  the  partial  removal  of  the  Ueuia  semi- 
circularis. 


FIGURATE   SURFACE.  165 

In  making  an  examination  of  the  brain  for  pathological  observation, 
this  section  is  one  of  great  importance,  exhibiting  clearly  the  color  of 
this  ganglion  ;  and  it  is  hoped  that,  for  the  future,  medical  men  will  not 
omit  in  their  accounts  of  post-mortem  appearances,  a  detail  of  the  con- 
dition of  this  ganglion.  It  is,  indeed,  extraordinary,  that,  in  almost  all 
the  accounts  published  in  this  country,  of  the  condition  of  the  brain  in 
insanity,  not  one  word  is  said  of  the  general  condition  or  color  of  this 
ganglion,  though  all  physiological  evidence  proves  that  it  is  the  portion 
of  the  brain  with  which  the  intellect  is  immediately  connected. 

The  next  step  in  the  dissection  is  to  make  a  longitudinal  incision,  as 
represented  on  the  right  side  of  the  mesial  line  in  fig.  77,  commencing 
a  little  posterior  to  the  anterior  edge  of  the  corpus  Qallosum,  and  ex- 
tending backwards  in  a  line  parallel  to  the  mesial  line  as  far  as  the 
posterior  edge  of  this  commissure.  This  great  transverse  commissure 
may  be  seen  in  fig.  99,  partly  dissected.  This  incision  must  be  made 
carefully,  and  not  extend  deeper  than  a  line  or  two.  It  will  open  what 
appears  to  be  a  circumscribed  cavity:  it  is  a  fissure  called  the  lateral 
ventricle  (fig.  77,  LV).  This  space  must  not,  however,  be  viewed  by 
the  student  in  the  light  of  a  cell  or  cavity,  situated  in  thfe  interior  of 
the  brain,  the  walls  of  which  are  formed  by  the  cerebral  mass ;  he  must 
consider  it  resulting  merely  from  the  contact  of  the  different  surfaces  of 
the  brain.  And  this  fissure  is  analogous,  in  fact,  to  the  fissure  between 
the  two  hemispheres  which  contains  the  falx  major  of  the  dura  mater, 
or  the  space  between  the  cerebrum  and  cerebellum  ;  the  only  difference 
being  that  the  last  mentioned  spaces  are  between  the  external  or  convo- 
luted surfaces  of  the  brain,  instead  of  between  the  under  part  of  the 
great  transverse  commissure  and  the  upper  part  of  what  has  been  called, 
in  distinction  to  the  convoluted,  the  figurate  or  figured  surface  of  the 
brain. 

It  is  quite  true  that,  in  one  sense,  it  is  a  cavity  with  walls  sufficiently 
perfect  to  be  capable  of  containing  fluid  ;  but  the  important  point  for  the 
student  to  understand  is,  that  these  walls  are  not  entirely  formed  by 
neurine,  and  that  its  power  of  containing  fluid  arises  simply  from  the 
mode  in  which  the  arachnoid  membrane  is  reflected  from  the  figurate 
surface  on  to  the  convoluted  surface.  It  is  in  this  way  that  we  have  a 
circumscribed  cavity,  formed  from  a  mere  accident  in  structure,  which, 
in  the  constitution  of  the  brain,  amounts  to  no  more  than  an  irregular 
but  extensive  fissure,  analogous,  in  all  respects,  to  the  fissures  between 
the  different  convolutions  of  the  cerebrum.  Though  it  may  not,  per- 
haps, be  possible  for  the  student,  who  has  only  advanced  thus  far  in  the 
dissection  of  the  brain,  to  have  a  clear  idea  of  the  difference  between 
the  figurate  and  convoluted  surfaces,  I  have  considered  it  advisable  to 
arrest,  in  the  very  first  instance,  any  ideas  that  might  arise  in  his  mind 
as  to  the  ventricles  of  the  brain  being  perfect  cavities,  whose  walls  are 
wholly  formed  by  the  substance  of  the  organ  itself.  The  terra  ventricle 
alone  is  sufficient  to  mislead  any  one  who  dissects  these  parts  for  the 
first  time. 

The  figurate  surface  of  the  brain  is  so  named,  in  contradistinction  to 
the  convoluted  surface,  from  the  projections  which  compose  it  presenting 
regular  forms  and  having  received  individual  names,  generally  derived 


166  HUMAN   BRAIN. 

from  some  trifling  peculiarity  of  appearance,  some  fancied  resemblance 
to  another  part,  or  erroneous  views  of  their  functions  ;  nevertheless, 
however  incorrect  these  titles  may  really  be,  it  would  not  be  advisable  to 
attempt  any  sudden  and  total  rejection  of  them ;  all  we  shall  do  will  be 
to  couple  with  them  other  appellations  which  have  relation  to  the  struc- 
ture and  function  of  the  part  they  are  used  to  indicate. 

A  portion  of  the  figurate  surface,  and  what  is  usually  called  the  body 
of  the  lateral  ventricle,  having  been  exposed  by  the  removal  of  a  portion 
of  the  transverse  commissure,  we  will  consider  these  parts  in  order  (see 
figs.  77  and  78). 

Commencing  anteriorly,  the  first  of  the  component  parts  of  the  figurate 
surface  which  presents  itself  to  our  observation  is  the  anterior  cerebral 
ganglion,  or  ganglion  of  the  anterior  or  motor  columns,  the  corpus 
striatum  (M  M),  whose  under  surface  we  have  to  examine.  It  is  pear- 
shaped,  the  base  of  the  pear  being  forwards  and  inwards,  and  the  apex 
or  small  end  lying  backwards.  Anterior  to  this  ganglion  is  a  deeper 
portion  of  the  ventricle,  the  anterior  cornu  (a  c}:  it  is  separated  from  its 
fellow  on  the  opposite  side  by  a  portion  of  the  longitudinal  commissure 
called  the  septum  lucidum  (s  I,  fig.  77 — No.  1,  fig.  78).  Between  the  two 
layers  of  the  septum  lucidum  is  the  fifth  ventricle  (5  v).  Posterior  to 
this  anterior  cerebral  or  motory  ganglion  is  a  vascular  membrane,  the 
plexus  choroides  (p  c) ;  this  membrane,  notwithstanding  its  grand  name,  is 
merely  the  continuation  of  the  pia  mater,  as  will  be  seen  a  little  further  on  ; 
if  this  membrane  is  raised  (see  the  left  side  of  fig.  77),  another  large  gan- 
glion may  be  seen  (the  posterior  cerebral),  presenting  a  white  surface,  and 
rounded  from  the  thalamus  nervi  optici  (K),  through  which  the  posterior  or 
sensory  columns  pass  previously  to  their  expansion  in  the  hemisphere  and 
termination  in  the  hemispherical  ganglion  (fig.  77,  B). 

The  whole  of  the  thalamus  is  not  yet  exposed,  the  posterior  portion 
being  covered  by  the  fornix  (see  the  left  side).  The  thalamus  nervi  optici 
is  larger  in  man  than  inany  other  animal,  and  as  we  have  traced  it  upwards 
we  have  found  it  in  many  of  the  higher  Mammalia,  as  in  the  horse,  sheep, 
&c.,  assuming  a  triangular  form,  at  first  so  narrow  that  we  find  it  in  the 
mole  almost  of  the  form  of  a  scythe.  These  two  ganglia  are  not  so  closely 
united  in  some  of  the  lower  animals  as  in  man  :  in  the  cat  the  separation 
is  very  evident,  and  still  more  so  in  the  mole. 

Between  these  two  ganglia  is  situated  a  narrow  band  of  medullary 
neurine,  called,  from  its  appearance,  the  taenia  semicircularis  (fig.  77,  t  c, 
fig.  78,  4) ;  the  fibres  composing  the  band  are  connected  with  the  supe- 
rior longitudinal  commissure,  and  are  considered  by  Spurzheim  as  the 
media  connecting  the  conveying  fibres,  or  fibres  of  communication, 
between  the  two  hemispheres  and  anterior  and  posterior  cerebral  ganglia 
(see  fig.  101,5).  Beneath  the  taenia  semicircularis  is  a  large  vein,  the 
vena  Galeni,  so  called  after  Galen  (fig.  77,  v  g ;  78,  3).  At  the  pos- 
terior extremity  of  the  thalamus,  and  extending  rather  beneath  this  gan- 
glion, are  two  rounded  bodies,  which  are  called  the  external  and  internal 
geniculate  bodies ;  at  first  sight  they  appear  as  if  they  were  a  portion 
of  this  ganglion,  but  I  believe  that  they  are  merely  in  opposition.  They 
will  be  better  seen  in  a  further  stage  of  the  dissection. 

Overlapping  the  internal  and  posterior  part  of  the  posterior  cerebral 


VENTRICLES. 

Fig.  78. 


167 


K: 


In  this  drawing  may  be  seen  all  the  ventricles  of  the  brain.  The  upper  part  of  both  hemispheres  have 
been  removed  with  the  corpus  callosum  on  a  plane  a  little  below  that  commissure,  and  the  section  ex- 
hibited in  the  last  drawing.  The  posterior  lobe  of  the  left  hemisphere  of  the  cerebrum  has  also  been 
removed.  The  cerebellum  has  been  entirely  removed,  in  order  to  show  the  posterior  surface  of  the 
medulla  oblongata.  On  the  right  side  the  hemisphere  has  been  cut  away  still  lower,  to  expose  the 
posterior  and  descending  cornuae  of  the  lateral  ventricle.  A  piece  of  bristle  is  passed  from  the  fourth 
ventricle  through  the  iter  a  quarto  ad  tertium  ventriculum.  Thus  is  shown  the  posterior  fissure  of  the 
cord,  PF,  suddenly  dilated,  1st,  into  the  fourth  ventricle,  4<&  y,  or  calamus  scriptorius;  2dly,  into  the  iter 
a  quarto  ad  tertium  ventriculum;  3dly,  into  the  third  ventricle,  3d  v;  and  4thly,  into  the  fifth  ventricle, 
5  v.  In  the  fourth  ventricle  may  be  seen  two  pyramidal  bodies,  the  auditory  ganglia,  F;  the  white  lines 
crossing  them  are  the  roots  of  the  auditory  nerves.  The  iter  a  quarto  ad  tertium  ventriculum  is  first 
bounded  above  by  the  inter-cerebral  commissure,  i&c;  2dly,  by  the  optic  tubercles,  DC,  carrying  the 
pineal  gland,  R.  The  bristle  emerges  in  the  third  ventricle,  bounded  above  by  the  fornix,  which  is 
removed,  and  laterally  by  the  optic  thalami,  K,  on  the  edges  of  which  may  be  seen  the  peduncles  of  the 
pineal  gland.  Anteriorly  the  third  ventricle  is  bounded  by  two  rounded  cords,  NN,  the  anterior  pillars 
of  the  inferior  longitudinal  commissure — fornix.  In  front  of  these  is  another  narrow  chink  or  fissure,  5, 
the  fifth  ventricle.  The  white  lines,  which  bound  this  cavity,  are  the  cut  edges  of  that  portion  of  the 
longitudinal  commissure  which  is  called  the  septum  lueidum.  On  either  side  of  the  mesial  fissure  are 
the  lateral  ventricles,  2  2,  with  their  eornua,  anterior,  AH,  middle  descending,  De,  and  posterior,  PO.  BB. 
Hemispherical  ganglion,  or  cortical  substance  of  the  brain,  c.  Anterior  optic  ganglion,  nates ;  D.  Poste- 
rior ditto,  testes — covering  the  iter  a  tertio  ad  quartum  ventriculum.  F.  Auditory  ganglion  in  the  fourth 
ventricle,  4th.  v.  H.  Spinal  cord.  K.  Thalamus  nervi  optici,  posterior  cerebral  ganglion.  M  M.  Corpus 
striatum,  anterior  cerebral  ganglion,  o.  Pineal  commissure.  R.  Pineal  gland,  i&c.  Inter-cerebral  com- 
missure, or  processus  e  cerebeao  ad  testes,  covering  the  iter  a  tertio.  s  c.  Soft  commissure,  commissura 
mollis.  LV.  Lateral  ventricles.  3d  v.  Third  ventricle;  \th  v.  Fourth  ditto;  5  v.  Fifth  ditto.  These  three 
are  all  dilatations  of  PF,  posterior  fissure  of  the  spinal  cord.  1.  Septum  lueidum.  a  portion  of  the  inferior 
longitudinal  commissure  or  fornix.  This  is  represented  much  too  thick.  2.  Anterior  pillars  of  fornix 
divided.  3.  Vena  Galeni.  4.  Taenia  semicircularis.  5.  Corpus  striatum  divided.  6.  Hippocampal 
lobe,  or  hippocampus  major.  7.  Taenia  hippocampi,  or  descending  pillar  of  the  fornix.  8.  Corpus  den- 
tatum.  9.  Emminentia  collateralis.  All  these  last  are  situated  in  the  descending  cornu  of  the  lateral 
ventricle.  10.  Hippocampus  minor  in  the  posterior  cornu  of  the  lateral  ventricles,  d.  Fourth  pair  of 
nerres,  pathetic,  h.  Eighth  pair,  or  auditory. 


168  HUMAN   BRAIN. 

ganglion  or  thalamus,  there  is  a  sharp  band  of  medullary  neurine;  this 
structure  is  a  portion  of  the  inferior  longitudinal  commissure  or  fornix 
(figs.  77,  78,  N,  101,  E).  The  connections  and  precise  character  of  this 
commissure  I  shall  not  describe  at  present,  being  anxious  to  give  a 
connected  and  uninterrupted  view  of  the  figurate  surface,  merely  re- 
marking that  the  width  and  extent  of  the  superior  portion  of  the  fornix 
or  inferior  longitudinal  commissure  may  be  observed  by  dividing  the 
remainder  of  the  transverse  about  one-third  from  its  posterior  edge  in 
the  direction  of  the  cerebellum.  Before  doing  this,  the  student  may 
consider  that  he  has  now  seen  the  contents  of  the  body  of  the  lateral 
ventricle — corpus  striatum,  vena  Galeni,  tsenia  semicircularis,  thalamus 
nervi  optici,  plexus  choroides,  and  fornix.  On  removing  the  rest  of  the 
transverse  commissure,  the  fornix  will  be  found  to  extend  on  each  side 
nearly  an  inch  from  the  mesial  line,  narrowing  considerably  towards  its 
anterior  extremity.  It  will  also  be  found  extending  downwards  and 
outwards  into  a  narrow  curved  chamber,  continuous  with  the  lateral 
ventricle,  called  the  descending  cornu  (fig.  77,  7).  The  descending 
cornu  extends  first  backwards,  then  outwards,  forwards,  and  inwards, 
thus  forming  a  curve,  the  convexity  of  which  is  backwards  and  out- 
wards, the  concavity  forwards  and  inwards.  As  the  student  is  still  re- 
quired to  describe,  at  his  examinations,  the  contents  of  this  cavity,  they 
may  be  thus  enumerated  as  also  six  in  number  (see  fig.  78).  Their 
anatomical  and  physiological  relations  will  be  explained  with  the  com- 
missures. The  contents  of  this  cornu  all  take  the  curve  of  the  cavity, 
and  may  be  described  from  within  outwards  : — A  slight  projection  ;  1st. 
Emminentia  collaterals  (9) ;  2dly.  Hippocampus  major  (6),  terminating 
below  in — 3dly.  A  club-like  extremity  of  the  body — Pes  hippocampi; 
4thly.  TaBnia  hippocampi  (7),  a  continuation  of  the  fornix,  on  raising 
which,  the  gray  neurine  of  the  convoluted  surface  at  the  base  of  the 
brain  may  be  seen  serrated  by  the  entrance  of  blood-vessels ;  5thly. 
Fascia  dentata(9);  Gthly.  Plexus  choroides,  lying  over  all  these.  The 
lateral  ventricle  also  extends  backwards,  the  posterior  cornu  forming  a 
curve,  convex  outwardly,  concave  internally  ;  the  projection  on  its  inner 
wall  is  called  the  Hippocampus  minor (10). 

The  right  side  of  the  longitudinal  commissure  must  next  be  completely 
divided,  cutting  towards  the  upper  surface  of  the  cerebellum,  and  the 
divided  portions  turned  to  either  side,  separating  them  about  half  an 
inch.  The  consequence  of  this  section  will,  in  the  first  instance,  be  the 
further  exposure  of  the  pia  rnater,  and  a  view  of  the  exact  point  where 
it  quits  the  convoluted  to  join  the  Jigurate  surface  ;  the  convoluted  sur- 
face, which  the  pia  mater  quits,  is  the  upper  surface  of  the  cerebellum. 
The  narrow  space  left  between  the  under  surface  of  the  posterior  edge 
of  the  inferior  longitudinal  commissure  and  the  upper  surface  of  the  cere- 
bellum, is  called  the  foramen  of  Bichat,  and  the  pia  mater  in  this  situa- 
tion is  known  by  the  name  of  velum  interpositum.  This  membrane,  the 
velum  interpositum,  must  now  be  very  carefully  raised,  and  immediately 
underneath  and  connected  with  it  will  be  found  a  small  rounded  body 
about  the  size  of  a  pea,  consisting  of  cineritious  neurine,  the  pineal 
gland  R,  and  frequently  containing  in  its  interior  some  gritty  matter 
called  the  acervulus  cerebri ;  it  forms,  together  with  two  white  bands, 


FIGURATE    SURFACE. 


169 


hitherto  known  by  the  title  of  the  peduncles  (o)  of  the  pineal  gland,  con- 
nected to  it,  a  commissure  between  the  optic  thalami.  The  whole 
structure  may  be  called  the  pineal  commissure.  Beneath  this  commis- 
sure are  situated  the  optic  tubercles,  which  in  man,  as  we  have  seen  in 
the  Mammalia  generally,  are  four  in  number,  instead  of  being  simply 
binary,  as  in  fishes;  these  tubercles  are  usually  known  by  the  term  cor- 
pora  quadrigemina.  The  anterior  of  these  are  the  largest,  and  are  called 
the  nates  (c),  the  posterior  the  testes  (D). 

The  geniculate  bodies  may  now  be  seen  more  distinctly,  the  external 
the  smallest,  the  internal  the  largest.  A  band  of  medullary  neurine  may 
be  seen  running  from  the  testes  to  the  external,  and  from  the  nates  to  the 
internal.  The  optic  nerves  send  fibres  into  their  substance,  to  be  de- 
scribed elsewhere  (fig.  106). 


Fig.  79. 


Fig.  80. 


Fig.  79.— A.  Medulla  oblongata.  B.  Pons  Varolii.  c.  Tubercula  quadrigemina.  with  the  fibres  of  the 
posterior  columns  passing  in  front.  D.  Crus  cerebri,  fibres  of  the  anterior  columns.  E.  Thalamus,  or 
posterior  striated  body.  F.  Anterior  striated  body.  G.  Substance  of  the  hemisphere,  springing  out  from 
the  front  of  the  anterior  corpus  striatum.  H.  Space  between  the  striated  bodies  and  the  hemispheres 
caused  by  the  introduction  of  a  small  piece  of  wood.  i.  The  two  surfaces,  being  in  contactinthe  natural 
state.  K.  Fissura  Sylvii. 

Fig.  80— represents  the  same  parts  shown  by  a  transverse  section  through  the  centre  of  one  side  of 
the  brain. 

By  gently  raising  the  anterior  edge  of  the  cerebellum  with  his  knife, 
(and  this  must  be  done  with  great  care,  to  avoid  injuring  the  fourth  pair 
of  nerves  (d),  which  lie  immediately  beneath,)  the  student  will  observe, 
passing  from  the  optic  tubercles  backwards  and  downwards  to  the  cere- 
bellum, a  broad  band  of  medullary  neurine,  thick  laterally,  but  extremely 
thin  in  the  centre  ;  so  great  is  the  difference  in  the  texture  of  these  two 
portions,  that  the  central  has  been  callec)  the  Valve  of  Vieussens  ;  the 
direction  of  the  component  fibres  is,  however,  the  same  in  both.  This 
structure  in  the  aggregate  must  be  regarded  as  a  commissure,  connect- 
ing the  cerebrum  and  cerebellum,  and  I  have  designated  it,  therefore, 
the  inter-cerebral  commissure  (i  &  c,  see  fig.  78).  A  more  minute  de- 
scription of  its  fibres  will  be  found  under  the  head  of  commissures. 
This  view  of  thefigurate  surface  of  the  brain  will  remind  the  student  of 
the  tubercular  form  of  the  brain  of  the  fish,  to  which  it  bears  some  re- 
semblance, exhibiting — 1st.  Corpus  striatum,  the  anterior — the  motor 
ganglion  of  the  spinal  cord.  2d.  Thalamus  nervi  optici — the  posterior 
or  sensory  ganglion  of  the  spinal  cord.  3d.  The  inter-cerebral  commis- 


170  HUMAN   BRAIN. 

f 

sure  and  cerebellum.  The  olfactory  tubercles  which  in  the  fish  are  ex- 
posed, the  hemispheres  being  too  small  to  cover  them,  are  concealed  in 
this  view  of  the  human  brain,  as  indeed  were  the  rest,  until  the  hemi- 
spheres were  divided  and  turned  back.  The  relation  of  the  hemispheres 
to  the  ganglia  of  the  cord,  or  corpora  striata  and  optic  thalami,  will  be 
easily  understood  by  referring  to  the  accompanying  diagram,  where  the 
convoluted  surface  is  represented  as  commencing  at  the  fissura  Sylvii, 
from  which  it  is  traced,  first  forwards  then  upwards,  then  backwards  to 
the  posterior  extremity,  and  then  forwards  again  under  the  striated 
bodies  to  the  fissura  Sylvii. 

We  may  thus  compare  the  corpus  striatum  and  thalamus  nervi  optici, 
or  anterior  and  posterior  cerebral  ganglia,  to  the  head  of  a  stick,  to  the 
neck  of  which,  just  below  the  knob,  is  attached  a  piece  of  folded  linen 
(represented  by  the  hemispheres,  in  the  human  subject  an  immense  sur- 
face), which  is  first  drawn  forwards,  next  turned  backwards,  and  again 
brought  forwards  so  as  to  form  a  complete  covering  to  the  head. 


171 


PART  VI. 

DISSECTION  OF  THE  HUMAN  BRAIN  AND  SPINAL  CORD. 

Spinal  Cord,  or  Medulla  Spinalis. — The  student  should  not  attempt 
the  dissection  of  the  brain  and  spinal  cord  until  he  has  prepared  it,  by 
hardening  it  in  alcohol,  dilute  muriatic  and  nitric  acids,  or  salt  and 
water.  Cruveilhier  recommends,  instead  of  hardening  the  brain  by 
artificial  methods,  to  expose  its  structure  by  jets  of  cold  water  thrown 
upon  it ;  though  he  allows  that  results  obtained  by  this  method  confirm 
those  furnished  by  the  study  of  its  structure  when  hardened  by  alcohol.* 

In  conformity  with  the  principles  which  induced  me  to  preface  the 
study  of  the  cerebro-spinal  axis  in  the  human  being  with  a  demonstra- 
tion of  the  progressive  development  of  the  nervous  system  by  tracing  it 
in  some  of  the  simplest  animals,  we  shall  commence  this  division  of  our 
labors  with  an  account  of  the  configuration  and  structure  of  that  por- 
tion of  this  system  which,  protected  by  the  vertebral  column,  is  known 
by  the  name  of  spinal  cord.  Without  an  accurate  knowledge  of  the 
component  parts  of  the  cord,  no  one  can  ever  comprehend  the  intricate 
structure  and  mode  of  composition  of  the  other  portion  of  the  system, 
which,  included  within  the  cranium,  is  therefore  entitled  the  encephalon, 
or  brain. 

The  spinal  cord  consists  of  two  halves  or  corresponding  portions, 
placed,  as  regards  the  mesial  line  of  the  body,  laterally  to  each  other, 
and  united  anteriorly  by  a  central  commissure  composed  of  medullary 
neurine  (fig.  82,  No.  1).  The  fissures  separating  these  two  halves  of 
the  cord  are  designated  the  anterior  and  posterior  fissures  of  the  spinal 
cord. 

The  anterior  fissure  differs  from  the  posterior  in  being  wider,  more 
distinct,  and  therefore  more  easily  demonstrated,  though  it  is  not  so  deep 
at  the  upper  part  of  the  spinal  cord  as  the  posterior ;  it  deepens,  how- 
ever, as  we  descend,  and  is  the  deeper  of  the  two  towards  the  sacral 
end  of  the  cord.  The  pia  mater,  which  closely  invests  the  cord,  dips 
into  the  anterior  fissure,  but  nevertheless  requires  to  be  carefully  dis- 
sected off  before  the  cleft  can  be  distinctly  shown.  As  the  sides  of  the 
posterior  fissure  are  in  closer  contact  than  those  of  the  anterior,  more 
difficulty  is  met  with  in  introducing  the  point  of  the  scalpel  into  the 
posterior  fissure  without  injuring  the  medullary  substance.  It  is  curious 
that  so  much  difference  of  opinion  should  have  existed  among  anatomists 

*  Cruveilhier,  t.  iv.  560,  op.  cit.,  states,  that  the  earliest  description  of  the  spinal  cord 
worthy  of  mention  is  that  of  Huber,  (J.  Huber  de  medulla  spinali:  Goettingcen,  1741),  and 
that  it  served  as  the  basis  of  the  labors  of  Haller. 


172  HUMAN   BRAIN. 

as  to  the  character  of  these  fissures,  Haller  almost  doubting  the  existence 
of  the  anterior  one,  whilst  Chaussier  states  that  it  is  deeper  than  the  pos- 
terior ;  and  Gordon  and  others,  again,  stating  that  in  point  of  depth 
there  is  scarcely  any  difference  between  them.  Connected  with  the 
spinal  cord,  there  are  thirty-one  pairs  of  nerves,  each  nerve  being  in 
communication  with  the  medulla  spinalis  by  two  sets  of  filaments,  which, 

in   the   ordinary  language  of  anatomists, 

Fig-  8L  are  called  the  anterior  and  posterior  roots 

of  the  spinal  nerves  (see  fig.  81).  But 
viewing  the  connection  of  these  nerves 
with  the  cord  in  strict  accordance  with 
the  functions  which  they  severally  per- 
form, it  would  be  more  correct  to  say  that 
the  anterior  filaments  alone  arise  from  the 
cord,  and  that  the  posterior  terminate 
there ;  for  the  anterior  filaments  have 
been  proved  by  Sir  Charles  Bell  and  Ma- 
gendie  to  be  the  conductors  of  the  will  to 
section  opposite  the  root  of  the  fifth  spi-  the  voluntary  muscles  :  thev  are,  in  fact, 

nal  nerve.    1.  Anterior  or  motor  root  of       ,  J  .       J  3  .' 

the  spinal  nerves.    2.  Posterior  or  sensory      the    instruments    01    Volition,     the     CXperi- 

guon°f  the  spinal  nerves'  with  ments  of  the  physiologists  named  having 

proved,  that,  after  the  division  of  the  an- 
terior filaments,  the  limb  to  which  their  continuation  as  nerves  is  trans- 
mitted becomes  perfectly  paralytic  as  regards  voluntary  motion. 

The  posterior  roots  again  convey  sensation  through  the  medium  of  the 
cord  to  the  seat  of  consciousness,  the  cerebral  hemispheres. 

The  anterior  roots  are  much  smaller  than  the  posterior.  The  posterior 
are  further  distinguished  from  the  anterior  in  the  circumstance  of  their 
passing  through  a  distinct  ganglion  previous  to  their  connection  with  the 
cord  (see  fig.  81).  The  spinal  nerves,  however,  have  been  lately  proved 
to  be  not  merely  continuous  with  the  constituent  fibres  of  the  medullary 
or  fibrous  neurine  of  the  cord,  but  with  the  gray  neurine  which  is  con- 
tained in  its  interior,  as  will  be  described  a  little  further  on. 

Transverse  Section. — A  transverse  section  of  the  cord  demonstrates 
clearly  that,  with  the  exception  of  the  anterior  and  posterior  fissures,  it 
it  solid  throughout.  Nevertheless  different  anatomists  have  maintained 
that  there  was  a  canal  in  the  interior  of  it,  some  not  giving  it  any  precise 
situation,  and  others,  as  Portal  and  Morgagni,  describing  it  as  being 
situated  in  the  middle  of  the  cord,  lined  by  a  delicate  membrane.  Gall 
and  Spurzheim,  in  their  folio  work,  described  two  canals  running  through 
the  whole  length  of  the  cord,  not  communicating  with  each  other,  nor 
with  the  ventricles,  but  terminating  in  a  cul-de-sac  about  the  size  of  an 
almond  in  the  optic  thalami.  Spurzheim  has  since  stated*  that  such 
canals  were  produced  by  the  action  of  the  blow-pipe.  The  canal  which 
exists  in  the  foetal  state  is  but  a  dilatation  of  the  posterior  fissure,  and  is 
gradually  diminished  by  the  deposition  of  neurine;  for  the  pia  mater  by 
which  it  is  secreted  forms  a  deep  fold  posteriorly,  the  secretion  first  com- 
mencing from  the  concave  internal  surface  anteriorly,  and  being  con- 
tinued till  this  surface  becomes  level  and  the  whole  cord  solid. 

*  In  the  Anatomy  of  the  Brain,  8vo.,  London,  1820,  translated  by  Dr.  Willis. 


DISSECTION   OF   THE   SPINAL   CORD. 


173 


I  am  glad  to  find  that,  notwithstanding  the  opinions  of  Drs.  Stilling 
and  Wallach  regarding  the  existence  of  a  canal,  and  this  in  the  gray 
substance,  my  denial  of  its  existence  is  supported  by  the  observations  of 
Dr.  Todd,  who  says,  "  I  have  never,  after  numberless  experiments,  been 
able  to  see  it."— P.  635,  op.  cit. 

The  transverse  section  shows  that  the  cord  which  externally  seems 
composed  alone  of  fibrous  neurine,  contains  in  its  interior  a  considerable 
deposit  of  the  pulpy  matter. 

The  quantity  of  gray  matter  included  differs  very  much  in  different 
portions  of  the  cord,  as  may  be  seen  in  fig.  82,  Nos.  1,  2,  3,  4,  5,  6,  7, 
8  ;  a  circumstance  which  I  have  before  adverted  to  as  throwing  some 
light  on  the  different  offices  of  each  kind  of  neurine.  The  arrangement 
of  the  cineritious  neurine  is  definite  and  clear,  the  shape  of  the  included 
mass,  which  is  best  seen  by  a  transverse  section,  something  resembling 
two  C's  placed  back  to  back  and  connected  by  a  narrow  line  thus,  )-(. 
The  anterior  horns  do  not  reach  the  surface  of  the  cord  ;  but  the  posterior, 
extending  completely  through  its  substance,  attain  the  surface  at  those 
points  where  the  posterior  roots  of  the  spinal  nerves  are  connected  with 
the  cord  (see  fig.  82,  No.  1). 

Fig.  82. 


Sections  of  the  spinal  Cord.  1.  Opposite  the  third  cervical  vertebra,  with  the  anterior  and  posterior 
foots  of  the  spinal  nerves,  and  the  white  transverse  commissure.  2.  Opposite  the  fourth  ditto.  3.  Oppo- 
site the  seventh  ditto.  4.  Opposite  the  fifth  dorsal  vertebra.  5.  Opposite  the  eighth  ditto.  6  Opposite  the 
tenth  ditto.  7.  Opposite  the  eleventh  ditto.  8.  Opposite  the  first  lumbar  vertebra.  A.  Corda  equina. 
This  last  section  exhibits  very  clearly  the  great  diminution  in  the  quantity  of  fibrous  neurine  in  this  part 
of  the  cord,  as  compared  with  the  cervical  region;  the  bulk  of  the  cord  being  maintained  by  the  large 
quantity  of  vesicular  neurine.  The  diminution  in  the  quantity  of  fibrous  neurine  is,  of  course,  the  result 
of  its  having  been  gradually  distributed  by  the  nerves ;  each  nerve  from  the  first  cervical  downwards 
carrying  off  a  few  filaments. 

. 


174  HUMAN   BRAIN, 

This  cineritious  neurine  must  be  regarded  as  constituting  a  chain  of 
ganglia,  and  not  as  one  continuous  ganglion;  each  set  of  spinal  nerves 
having  its  own  individual  nervous  centre  corresponding  to  its  osseous 
centre  or  vertebra.  It  is  only  by  thus  regarding  the  composition  of  the 
cord  that  we  can  account  for  the  uniformity  in  the  number  of  the  cervical 
vertebras  in  Mammalia;  the  number  of  the  bones  being  regulated  by  the 
number  of  nervous  centres  requiring  protection.  The  reason  that  these 
are  uniform  in  Mammalia  is,  that  in  this  class  only  is  there  a  perfect 
muscular  diaphragm,  with  a  phrenic  nerve,  having  its  specific  number 
of  roots  and  corresponding  number  of  ganglia.  The  anatomical  con- 
tinuity of  this  gray  matter,  and  its  physiological  or  functional  separation 
into  distinct  ganglia  or  centres,  is  another  fact  of  importance  to  show 
that  we  must  not  look  for  anatomical  lines  of  separation  in  order  to 
establish  distinction  of  function. 

If  we  attempt  to  divide  the  medullary  neurine  of  each  half  of  the  cord 
into  two  portions  or  columns,  the  separation  may  be  easily  made  without 
the  slightest  division  of  its  fibrous  neurine;  and  in  order  to  facilitate  the 
description  of  the  ultimate  course  of  the  fibres  of  the  cord  in  that  portion, 
to  be  spoken  of  hereafter  under  the  title  of  medulla  oblongata,  we  may 
consider  them  as  separate  parts  under  the  name  of  antero-lateral  and  pos-; 
terior  columns,  as  these  names  seem  calculated  to  excite  attention  to  the 
exact  relative  position  of  these  two  tracts  of  medullary  neurine.  The 
antero-lateral  is  so  much  larger  than  the  posterior,  that  it  not  merely 
constitutes  almost  the  whole  of  the  anterior  portion,  but  also  the  side 
of  the  cord.  The  relative  proportion  of  the  antero-lateral  and  posterior 
columns  varies,  however,  in  different  portions  of  the  cord.  In  the  cer- 
vical region,  for  example,  the  antero-lateral  is  nearly  double  the  size  of 
the  posterior.  In  the  lower  part  of  the  dorsal  and  upper  part  of  the 
lumbar  regions,  again,  it  is  not  more  than  one-fourth  larger. 

By  a  transverse  section  of  the  cord  we  are  also  enabled  to  observe  a 
set  of  medullary  fibres,  which,  running  horizontally  across  the  cord  from 
one  side  to  the  other,  connect  the  corresponding  halves  together.  This 
is  the  commissure  of  the  cord  before  spoken  of,  and  bears  a  perfect  ana- 
logy to  the  great  transverse  commissure  of  the  brain.  This  commissure 
forms  the  floor  of  the  anterior  median  fissure  (fig.  82,  No.  1). 

The  student  must  next  become  acquainted  with  the  connection  of  the 
anterior  and  posterior  roots  of  the  spinal  nerves  with  the  gray  matter  of 
the  cord ;  but  he  must  not  expect  to  dissect  this  easily  himself,  as  it  can 
only  be  discovered  when  the  animal  has  not  been  dead  more  than  an 
hour  or  two,  and  we  have  therefore  no  chance  of  exhibiting  it  in  the 
human  subject.  Gall  was  the  first  to  assert  that  the  spinal  nerves  are 
connected  with  the  gray  matter. 

Bellingeri  was,  I  believe,  the  first  who  demonstrated  the  double  origin 
of  the  spinal  nerves  from  the  gray  as  well  as  the  white  matter  of  the 
cord.*  The  reader  will  find  an  admirable  analysis  and  review  of  the 
contents  of  his  papers  in  vol.  42  of  the  Edinburgh  Medical  and  Surgical 
Journal,  from  which  I  have  taken  the  following  account :  Bellingeri 
believed  that  the  filaments  of  the  posterior  roots  of  the  spinal  nerves  have 

*  C.  F.  Bellingeri  de  Medulla  Spinali,  1823.     Experiments  in  Nervorum  Antagonismum 
habita  a  Carolo  F.  Bellingeri,  1824. 


ROOTS    OF   THE   SPINAL   NERVES.  175 

in  the  human  subject  at  least  three  different  origins,  viz. — from  the  pos- 
terior peaks  of  gray  matter,  from  the  posterior  lateral  fissures,  and  from 
the  posterior  columns  of  the  cord.  The  anterior  roots,  he  states  also, 
have  threefold  connection  with  the  antero-lateral  columns,  but  he  does 
not  clearly  make  out  their  connection  with  the  cineritious  neurine. 

Notwithstanding  this  announcement  by  Bellingeri  in  1823,  the  fact 
was  not  established,  or  generally  believed  in  this  country,  till  1837, 
when  Mr.  Grainger  published  his  interesting  and  philosophical  treatise, 
entitled,  "  Observations  on  the  Structure  and  Functions  of  the  Spinal 
Cord,"  in  which  he  distinctly  enunciates  this  important  truth.  And  as 
I  have  carefully  tested  his  assertion  by  several  dissections,  I  feel  no 
hesitation  in  giving  my  testimony  to  the  fact  that  both  the  anterior  and 
posterior  roots  are  connected  with  the  gray  matter  of  the  cord. 

Rolando  entertains  some  curious  opinions  regarding  the  arrangement 
of  the  medullary  fibres,  describing  them  as  if  they  constituted  an  exten- 
sive surface  folded  up  ;  and  he  gives  a  drawing  of  its  supposed  appear- 
ance in  a  bullock.  Cruveilhier  considers  it  to  be  laminated,  but  that 
each  lamina  is  separate  from  its  neighbor — an  observation  which  he  re- 
marks is  confirmed  by  pathological  analogy.* 

Mr.  Grainger  says — "  In  considering  the  interesting  phenomena  re- 
lated by  Dr.  M.  Hall,  it  occurred  to  me  that  it  might  be  possible  to 
demonstrate  the  separate  existence  of  what  he  has  called  the  incident 
and  reflex  fibres ;  and  I  was  thence  induced  to  dissect,  with  much  care, 
the  two  roots  of  the  spinal  nerves.  After  repeated  examinations,  I  satis- 
fied myself  that  each  was  connected  both  with  the  external  fibrous  part 
of  the  cord,  and  the  internal  gray  substance.  The  following  is  what 
appears  to  be  the  structure : — After  the  two  roots  have  perforated  the 
theca  vertebralis,  and  so  reached  the  surface  of  the  cord,  it  is  well 
known  that  their  fibres  begin  to  separate  from  each  other  ;  of  these  fibres 
some  are  lost  in  the  white  substance,  whilst  others  entering  more  deeply 
into  the  lateral  furrows  are  found  to  continue  their  course,  nearly  in  a 
right  angle  with  the  spinal  cord  itself,  as  far  as  the  gray  substance  in 
which  they  are  lost.  But  this  arrangement  has  no  resemblance  to  the 
distinct  division  into  fasciculi  depicted  by  Mr.  Mayo;  on  the  contrary, 
it  is  with  great  care  only  that  small,  delicate,  and  individual  threads  or 
striae,  as  it  were,  are  traced,  dipping  into  the  lateral  fissure,  and  at 
length  joining  the  gray  matter.  This  difficulty  is  owing  to  the  fact,  that 
whilst  the  fibres  on  the  outer  surface  of  the  pia  mater  adhere  very  in- 
timately with  that  strong  membrane,  on  its  inner  surface  the  neurilemma 
becomes  so  extremely  delicate  that  the  fibres  lose  much  of  their  firm- 
ness, and  break  on  the  application  of  the  least  force  ;  an  accident  which 
always  happens  if  the  pia  mater  be  raised  from  the  surface  of  the  spinal 
cord  beyond  the  point  where  the  nerves  are  attached.  When  the  fila- 
ments have  penetrated  into  the  fissure,  they  Jose  their  rounded  figure  and 
become  flattened,  and  are  then  seen  passing  to  the  gray  substance  at  a 
right  angle  to  the  longitudinal  fibres  of  the  cord.  It  is  extremely  diffi- 
cult, owing  to  the  delicacy  of  the  parts,  to  determine  the  exact  relations 
which  exist  between  the  above  filaments  and  the  gray  matter ;  but  in  a 

*  IV.  561,  op.  cit. 


176  HUMAN   BRAIN. 

few  dissections  I  have  been  able  to  see  these  fibrils  running  like  delicate 
striae  in  the  gray  substance.  In  one  instance,  the  fibres  being  more  dis- 
tinct than  usual,  an  appearance  was  presented  having  a  remarkable  re- 
semblance to  that  which  is  seen  on  making  a  section  of  the  corpus 
striatum  in  a  recent  brain,  after  the  manner  of  Spurzheim.  My  friend 
and  colleague,  Mr.  Cooper,  in  this  case  counted  distinctly  five  separate 
fibrils  passing  from  the  anterior  root  of  the  nerve  ;  and  there  were  some 
other  fibres  derived  from  the  same  root,  which  were  not  so  plainly  seen. 

"  From  numerous  examinations  I  am  induced  to  believe,  that  when- 
ever the  white  fibres  of  the  nervous  system  become  connected  with  the 
gray  substance,  whether  in  the  different  masses  of  the  brain,  in  the 
spinal  cord,  or  in  the  ganglions,  the  arrangement  is  similar  to  what  is 
seen  in  the  section  of  the  corpus  striatum,  to  which  reference  has  just 
been  made.  The  fibres  become,  as  it  were,  incrusted  with  the  gray 
matter,  a  disposition  which  may  even  be  seen  by  a  careful  inspection  in 
the  convolutions  of  the  cerebrum,  in  which  the  radiating  fibres  of  the 
crus  cerebri  are  observed  like  delicate  striae.  In  examining  the  roots  of 
the  nerves,  I  have  always  relied  on  the  assistance  of  the  naked  eye  only, 
avoiding,  for  fear  of  deception,  the  use  of  a  lens  ;  it  also  appeared  to  be 
preferable  to  dissect  the  parts  quite  in  their  recent  state,  so  that  the 
natural  structure  was  entirely  preserved.  The  method  of  Reil,  which 
is  so  useful  in  tracing  the  fibres  of  the  brain,  is  quite  inapplicable  in  the 
present  case ;  and  Bellingeri  has  shown  that  the  use  of  acid  renders  it 
very  difficult  to  distinguish  the  nervous  filaments  from  the  blood-vessels. 

"  The  structure  above  described  I  had  ascertained  several  months  ago, 
and  had,  at  that  time,  demonstrated  it  to  several  of  my  friends  ;  but  on 
visiting  Germany  I  found  so  much  skepticism,  or  rather  disbelief,  as  to 
the  alleged  connection  with  the  gray  matter,  more  especially  as  regards 
the  anterior  root,  that  I  very  carefully  repeated  the  dissections  several 
times  with  the  aid  of  an  excellent  anatomist,  Professor  Bischoff,  of  Hei- 
delberg, to  whom  I  am  much  indebted  for  the  facilities  he  afforded  me 
of  prosecuting  the  inquiry.  In  every  instance  in  which  the  parts  were 
sufficiently  favorable  for  examination,  I  distinctly  traced  the  connection 
of  both  roots  with  the  gray  substance  ;  and  it  is  very  satisfactory  to  me 
to  be  able  to  confirm  this  by  the  testimony  of  Professor  Bischoff',  who 
although  he  had  shared  in  the  doubts  before  mentioned,  has  given  me 
his  permission  to  state  that  he  is  convinced,  by  his  own  examinations, 
that  the  structure  above  described  really  exists. 

"  From  careful  dissection,  I  am  convinced  that  it  is  only  a  part  of  the 
fibres  belonging  to  the  two  roots  which  are  attached  to  the  gray  substance, 
and  that  a  considerable  number  of  threads  are  lost  in  the  fibrous  part  of 
the  cord.  The  exact  mode  of  their  connection,  however,  with  the  latter 
substance  is  not  known."* 

The  fibres  of  the  spinal  cord  are  very  simply  arranged,  lying  parallel 
to  each  other,  in  consequence  of  which  they  are  easily  stripped  off, 
leaving  the  surface  beneath  smooth  and  regular,  so  that,  as  Sir  Charles 
Bell  observes,  u  It  appears  that  the  superficial  layers  furnish  the  roots  of 
the  higher  nerves,  and  that  the  lower  layers  go  off  to  the  roots  of  the 
nerves  as  they  successively  arise." 

*  P.  34,  op.  cit 


DISSECTION   OF    SPINAL    CORD.  177 

The  following  observations  from  Dr.  Todd  are  worthy  of  attention,  as 
coming  from  such  a  pains-taking  physiologist ;  at  the  same  time  I  must 
again  repeat  my  conviction  of  the  accuracy  of  Mr.  Grainger's  account, 
p"  660.  "  This  question  respecting  the  precise  relation  of  the  roots  of 
the  nerves  to  the  cord,  is  one  of  those  in  which  physiology  in  a  certain 
sense  takes  the  lead  in  anatomy.  Experiment  has  made  it  certain,  that 
while  the  spinal  cord  serves  as  a  propagation  of  nervous  power  to  and 
from  the  brain,  as  in  the  ordinary  sensations  and  voluntary  movements 
of  the  trunk  and  extremities,  it  is  likewise  capable  of  acting  as  an  inde- 
pendent nervous  centre,  and  that  movements  of  a  very  definite  character 
may  be  produced  in  parts  connected  with  it,  even  after  all  communica- 
tion between  it  and  the  brain  has  been  cut  off.  And  it  has  been, 
supposed  by  one  of  the  zealous  laborers  in  this  department  of  physiology, 
that  a  distinct  series  of  nervous  fibres  is  devoted  to  each  class  of  actions, 
those,  namely,  of  sensation  and  volition,  and  those  which  are  independent 
of  the  brain.  Mr.  Grainger  was  the  first  who  offered  a  distinct  solution, 
of  the  anatomical  problem  which  arose  out  of  the  hypothesis.  Probable 
as  his  explanation  appears  to  be,  a  candid  review  of  the  observations 
which  have  been  hitherto  made  obliges  me  to  state  my  opinion,  that  the 
question  is  still  sub  ju dice,  and  that  further  research  is  necessary  to  prove 
unequivocally,  that  of  the  fibres  composing  the  roots  of  the  nerves,  some 
pass  upwards  and  enter  the  brain,  and  others  do  not  pass  beyond  the 
gray  matter  of  the  spinal  cord  ;  and  this  inquiry  demands  more  than 
ordinary  care,  for  the  mind  of  an  observer  would  be  easily  biased  by  so 
attractive  a  theory  as  that  above  referred  to." 

Dr.  Julius  Budge,  a  private  teacher  of  physiology  in  Bonn,  but  well 
known  as  an  industrious  contributor  to  physiological  science,  has  pub- 
lished, in  Muller,  Archives  for  1844,  a  most  important  paper  regarding 
this  disputed  point.  With  the  assistance  of  Mr.  Grainger,  I  have  followed 
him  in  his  observations,  and  we  both  can  speak  most  decidedly  as  to 
their  accuracy.  Fig.  83  is  from  two  drawings  made  at  one  time  from  thin 
slices  of  the  cord  of  the  frog  with  the  sptnal  nerve.  It  strikingly  corre- 
sponds with  those  of  Dr.  Budge,  whose  figures  I  had  not  access  to  at 
the  time,  and  I  had  not  seen  them  for  above  a  twelvemonth,  so  that  my 
own  may  be  considered  as  affording  independent  testimony.  Dr.  Budge 
quotes  the  observations  of  Drs.  Gall,  Keuffel,.a  pupil  of  Reil,  Bellingeri, 
Rolando,  Weber,  Valentin,  and  Stilling,  to  show  that  though  they  had 
discovered  the  connection  of  the  roots  of  the  spinal  nerves  with  the  gray 
substance  of  the  cord,  they  had  not  demonstrated  the  continuity  of  their 
fibres  with  those  of  the  columns  of  the  cord  up  to  the  brain.  Dr.  Budge's 
observations  were  made  on  the  frog ;  and  while  he  acknowledges  the 
great  difficulty  of  tracing  these  fibres,  he  satisfied  himself,  by  repeated 
dissections,  that  the  nervous  fibres  do  not  run,  as  Stilling  asserts,  trans- 
versely, but  go  forwards  towards  the  brain. 

He  generally  took  the  conus  terminalis  of  the  frog's  cord,  on  account 
of  its  tentiity.  He  found  a  change  in  the  color  of  the  fibres  from  a  blu- 
ish gray  to  a  yellowish  gray  ;  also  in  size  from  ^j^th  of  a  line  to  ^oth 
and  jo^th.  These  changes  are,  no  doubt,  owing  to  the  attenuation  of 
the  supporting  membrane,  as  the  tubules  enter  into  the  composition  of  the 
cord,  where  the  presence  of  the  membrane  is  not  required,  as  in  the 
12 


178 


HUMAN   BRAIN. 


nerves.  This  change  in  the  thickness  and  strength  of  the  membrane  is 
undoubtedly  one  great  cause  of  our  difficulty  in  tracing  the  continuity 
of  these  fibres  with  a  dissecting  knife.  In  taking  the  root  of  a  dorsal 
nerve,  he  found  it  dividing  into  two  fasciculi,  one  superficial  and  the  other 
deep.  The  superficial  forms  a  sort  of  twisted  curve,  and  then  ascends 
towards  the  brain.  (See  figs.  83  and  84.)  The  deeper  plunges  into  the 


Fig.  83. 


Fig.  84. 


Fig.  83. — Anterior  root  of  the  spinal  nerve  of  the  frog,  showing  the  twisted  arrangement  of  the  fibres 
at  tJieir  junction  with  the  cord,  and  the  continuity  of  fibre  towards  the  bfaiu.  A.  Spinal  nerve.  H.  Spinal 
cord.  cf.  Cerebral  fibres,  sf.  Spinal  ditto,  v  m.  Vesicular  neurine. 

Fig.  84.— Portion  of  the  spinal  cord  and  nerve.  (Budge.)  Magnified  300  times,  d.  Tenth  spinal  nerve. 
a.  The  upper  portion,  dividing  into  two  fasciculi,  cerebral  fibres,  b.  The  lovver  fasciculus,  curving  through 
the  vesicular  neurine  of  the  spinal  cord,  spinal  filameuts. 

gray  substance,  through  which  it  passes  onwards  also  to  the  brain;  this 
latter  part  I  doubt,  as  I  believe  that  these  terminate  here.  It  is  this  twist 
in  the  fibres  which  renders  it  so  difficult  to  trace  their  continuity,  and  hence 
have  arisen  the  doubts  which  have  been  lately  thrown  out  on  this  subject. 
If  the  fibres  of  volition  and  sensation  could  not  be  traced  continuously 
through  the  nerves  and  the  cord  up  to  the  brain,  then  are  all  the  dis- 
coveries of  Sir  Charles  Bell  impotent  and  inconclusive.  But  they  are 
not  so — Nature  never  contradicts  herself;  and  I  maintain  that  even  if 
\ve  could  not  detect  it  with  our  dissecting  knives  and  magnifying  lenses, 
the  simple  pathological  fact  known  to  all,  that  sanguineous  effusion  into 
one  corpus  striatum  causes  paralysis  of  the  opposite  side  of  the  body,  is 
quite  sufficient  to  prove  it. 

Foville*  gives  the  following  account  of  the  connection  of  the  spinal 
nerves  with  the  spinal  cord  : — u  The  lines  of  insertion  of  the  anterior 
and  posterior  nerves  that  we  have  pointed  out  as  dividing  each  half  of 
the  spinal  marrow  into  three  surfaces,  now  merit  our  attention.  When 
we  consider  them  superficially,  we  could  believe  that  they  sprung  from 
a  superficial  groove,  from  the  bottom  of  which  the  roots  are  detached. 
This  appearance  is  shown  particularly  upon  the  line  of  the  origin  of  the 
posterior  roots ;  but  with  the  anterior  we  quickly  perceive  that  there 
exists  simply  a  perforation  of  the  superficial  layer  very  fine  in  this  place, 


*  P.  136,  op.  cit. 


CONNECTION   OF   THE   SPINAL   NERVES.  179 

and  that  the  roots  traverse  this  layer  to  go  to  another.  To  demonstrate 
this  fact,  we  may,  after  having  considered  the  anterior  in  their  continuity 
with  the  substance  of  the  cord,  draw  them  slowly  and  with  caution  :  we 
thus  distinguish  very  clearly  the  nervous  layer  which  traverses  these 
anterior  roots.  The  width  of  this  layer  is  sufficient  to  banish  any  doubt 
on  the  subject.  The  demonstration  of  a  nervous  layer  traversing,  at  the 
same  time,  a  part  of  the  posterior  roots,  is  not  so  easy.  The  narrow  line 
from  which  it  appears  these  roots  are  detached,  particularly  in  infancy, 
is  very  different  from  the  neighboring  surfaces:  instead  of  presenting  a 
white  color,  distinct  from  the  regions  which  it  separates,  the  posterior 
line,  and  the  anterior  also,  but  in  a  less  degree,  presents  in  the  infant  a 
clear  gray  color,  semi-transparent,  across  which  we  see  a  part  of  the 
nervous  roots  penetrate  a  certain  depth,  and  contrast  their  perfect  white 
color  with  clear  gray  semi-transparent  tint  of  the  matter  they  traverse; 
but  by  looking  with  attention,  aided  by  the  microscope,  an  extremely 
fine  white  layer  covering  the  gray.  Besides,  in  plunging  obliquely  a 
stylet  into  the  thickness  of  this  gray  substance,  and  raising  it  in  the  direc- 
tion of  the  origins  of  the  nerves,  the  white  nervous  layer  which  covers 
the  subjacent  gray  matter  is  stretched  and  torn.  This  observation  seems 
sufficient  to  repel  the  idea  of  the  existence  of  a  furrow  from  which  the 
roots  of  the  spinal  nerves  leave."  Restates  distinctly  that  the  posterior 
roots  combine  with  the  white  fibrous  superficial  portions  of  the  posterior 
columns,  which  form  the  posterior  limits  of  their  roots,  that  the  other 
portion  of  the  posterior  roots  plunge  into  the  gray  substance  visible  on 
the  whole  layer  of  these  origins,  and  the  anterior  roots,  like  the  posterior, 
plunge  into  the  spinal  marrow,  and  partly  unite  with  the  fibrous  substance 
and  partly  with  the  gray.  The  spinal  marrow  of  the  infant  is  the  best 
for  these  observations. 

Foville,  after  stating  that  it  is  an  established  principle  that  all  the 
nerves  arising  from  the  same  column  have  analogous  functions,  in  ac- 
cordance with  the  fact  that  there  are  three  fasciculi  in  the  spinal  cord 
from  the  lumbar  region  to  the  brain,  arranges  the  nerves  thus: — "  1. 
Nerves  of  the  posterior  fasciculus  ;  2.  Nerves  of  the  anterior  fasciculus; 
3.  Nerves  of  the  middle  fasciculus.  He  divides  the  nerves  of  the  poste- 
rior column  into  common  and  special :  the  common  are  attached  to  the 
posterior  fasciculi  and  common  ganglia  ;  the  special  to  the  same  fasciculi, 
but  also  to  special  ganglia.  The  special  ganglia  are  the  cerebrum  and 
cerebellum  ;  the  auditory  and  trigeminal  for  the  cerebellum  ;  the  optic 
and  olfactory  for  the  cerebrum.  He  describes  the  spinal  accessory  as 
belonging  to  the  lateral  column  of  the  cord,  and  the  trigeminal  and 
pathetic  to  it  in  the  cranium.* 

From  the  statement  which  has  been  made  regarding  the  different  func- 
tions of  the  anterior  and  posterior  roots  of  the  spinal  nerves,  the  one 
being  destined  for  motion,  (he  other  for  sensation,  it  follows  as  a  neces- 
sary consequence  that  the  anterior  and  posterior  fibres  of  the  cord,  now 
the  continuity  of  the  fibres  of  the  nerves  with  their  respective  columns 
is  proved,  must  perform  corresponding  offices;  in  other  words,  that  the 
constituent  fibres  of  the  anterior  and  posterior  portions  of  the  cord  are 

*  Foville,  op.  cit.,  p.  493. 


180  HUMAN    BRAIN. 

themselves  implicated,  the  one  in  the  production  of  motion,  the  other  in 
the  conduction  of  what  is  called  common  sensation. 

These  two  portions  of  the  cord  are,  however,  so  closely  united  to- 
gether that  they  seem  to  constitute  no  more  than  a  single  organ,  although 
performing  as  distinct  offices,  in  reference  to  the  nervous  system,  as 
the  arteries  and  veins  do  in  the  vascular  ;  the  motor  columns  of  the  spi- 
nal cord,  in  fact, .commencing  from  the  cineritious  matter  which  forms 
the  cortical  or  exterior  portion  of  the  convolutions  of  the  cerebrum  and 
cerebellum,  and  terminating  in  the  substance  of  the  voluntary  muscles, 
the  sensory  columns  commencing  in  every  texture  of  the  body  and  ex- 
tending to  the  same  points  from  whence  the  anterior  arise,  to  wit,  the 
cineritious  matter  of  the  cerebrum,  just  as  the  arteries  convey  the  blood 
to  all  parts  of  the  body  and  the  veins  return  it,  the  arteries  commencing 
at  the  heart  and  ending  in  the  capillary  tissues  ;  the  veins  commencing 
in  the  capillary  tissues  of  every  organ,  and  terminating  in  the  heart. 

Anatomists  used  to  dispute  the  question  as  to  whether  the  spinal  cord 
should  be  considered  as  arising  from  the  brain,  or  the  brain  be  regarded 
as  an  enlargement  of  the  spinal  cord.  Phanagoras,  as  quoted  by  Galen,* 
from  the  fact  of  his  dissecting  the  brains  of  serpents  and  fishes,  regard- 
ing the  brain  as  a  production  of  the  spinal  cord;  while  later  authors, 
Hippocrates,  Vesalius,  Willis,  Varolius,  Haller,  Zinn,  Sabatier,  Winslow, 
Portal,  Chaussier,  and  Cuvier,  have  maintained  the  opposite  opinion. 
On  the  other  hand,  we  find  Tiedemann  and  Serres  maintaining,  as  the 
fathers  of  anatomy  did,  the  same  opinion,  from  a  belief  that  the  spinal 
cord  is  formed  before  the  brain,  which  opinion  is  decidedly  refuted  by 
Rolando,  who  states  that  the  rudiments  of  the  cerebro-spinal  system, 
from  its  earliest  appearance,  is  always  larger  at  its  anterior  or  cerebral 
extremity  than  elsewhere ;  and  that  Tiedemann  was  deceived  in  conse- 
quence of  the  cord  arriving  more  rapidly  at  a  state  of  perfection  from 
the  greater  simplicity  of  its  structure.  As  a  third  opinion,  I  may  men- 
tion Gall  and  Spurzheim,  who  consider  that  the  brain  no  more  arises 
from  the  spinal  cord  than  the  spinal  cord  does  from  the  brain  ;  that  they 
are,  in  fact,  several  existences.  This  last  opinion  appears  to  me  correct 
as  regards  the  cineritious  neurine,  but  not  in  reference  to  the  medullary. 
Indeed,  when  we  consider  the  different  offices  performed  by  the  two 
columns,  it  is  clear,  as  regards  the  function  of  the  cord,  that  the  anterior 
columns  ought  to  be  described  as  commencing  in  the  brain,  and  the  pos- 
terior as  terminating  there. 

Gall  and  Haller  have  compared  the  spinal  cord  in  man  with  the  series 
of  ganglia  in  insects  and  in  worms,  and  as  it  appears  to  me,  with  justice; 
for  although  Gall  may  have  erred  in  stating  that  there  are  actual  enlarge- 
ments in  the  spinal  cord  of  the  Vertebrata,  opposite  the  origin  of  the 
nerves,  nevertheless  the  offices  of  these  centres  must  be  analogous  in 
both  divisions  of  the  animal  kingdom  :  and  I  cannot  accord  with  that 
usually  accurate  anatomist,  M.  Cruveilhier,  in  regarding  them  as  merely 
the  analogues  of  the  ganglia  at  the  posterior  roots  of  the  spinal  nerves 
ui  man. 

The  gray  matter  in  the  interior  of  the  cord  is  quite  sufficient  in  itself 

•  See  Cruveilhier,  p.  50. 


STRUCTURE  OF  THE  MEDULLA  OBLONGATA, 


181 


Fig.  85. 


to  establish  their  identity,  and  the  reason  why  this  gray  matter  or  gan- 
glionic  portion  is  not  moulded  into  knobs  or  swellings  opposite  each  nerve 
in  the  Vertebrata,  as  it  is  in  the  Articulata,  is  because  the  same  quantity 
of  gray  matter  thus  arranged  would  offer  a  greater  diameter,  and,  con- 
sequently, require  a  much  wider  canal,  a  more  bulky  vertebral  column, 
and  a  larger  muscular  apparatus  to  move  it.  But  nature,  in  this  instance, 
as  in  every  other,  concentrates  her  instruments  of  power,  and  husbands 
her  materials. 

Cranial  Division  of  the  Cerebro- Spinal  Axis.— The  spinal  cord  must  now 
be  followed  into  the  skull,  and  its  connection  with  the  cerebral  mass  in- 
vestigated. In  strict  accordance  with  the  course  of  the  nervous  influence, 
we  ought  to  describe  the  voluntary  or  motory  strands  from  above  down- 
wards, and  those  for  sensation,  or  the  sensory,  from  below  upwards. 
But  as  this  mode  of  proceeding,  even  if  the  exact  line  of  demarcation 
between  them  had  been  ascertained,  would  greatly  increase  the  difficul- 
ties which  unavoidably  surround  every  mode  of  study  in  this  compli- 
cated organ,  we  must  not  attempt  a  plan  which,  however  correct  in  a 
physiological  point  of  view,  would  not  assist  us  in  our  endeavors  to 
obtain  correct  ideas  of  its  anatomical  structure.  At  the  same  time  it 
must  not  be  forgotten,  that  when  we  speak 
of  the  anterior  columns  as  running  up  to  be 
connected  with  the  cerebrum  and  cerebel- 
lum, our  language  is  not  merely  metaphorical, 
but  is  positively  physiologically  incorrect. 

Medulla  Oblongata. — The  spinal  cord, 
shortly  after  its  entrance  into  the  skull,  be- 
comes considerably  enlarged,  and  changes 
its  name  to  medulla  oblongata  (see  fig.  85). 
This  will  be  found  upon  section  to  be  entire- 
ly altered  as  regards  the  arrangement  of  the 
cineritious  neurine  contained  in  its  interior. 
And  here  let  it  be  distinctly  understood  that 
this  enlargement  is  not  occasioned  by  any 
swelling  of  the  fibrous  or  medullary  portion, 
but  by  the  deposit  of  cineritious  neurine  in 

greater  quantity  than  it  is  met  with  in  the  composition  of  the  cord;  by 
the  deposition,  too,  of  this  constituent  of  the  nervous  system  in  separate 
and  isolated  points  or  masses,  a  circumstance  which  does  not  appear 
to  me  to  have  received  the  attention  which  I  cannot  help  thinking  it 
deserves.  The  view  I  am  inclined  to  take  of  the  character  of  the  parts 
comprising  the  medulla  oblongata,  is  simply  this:  in  addition  to  the  co- 
lumns for  motion  and  sensation,  there  are  here  deposited,  and  imbedded 
to  a  certain  extent  in  its  substance,  six  ganglia,  three  on  each  side,  an- 
terior, lateral  and  posterior.  The  anterior  are  ovoid  bodies,  which  derive 
the  name  of  olivary  (corpora  olivaria)  from  their  form. 

We  have  seen  the  anterior  ganglia  in  most  of  the  Mammalia,  though 
not  always  u cropping  out  on  the  surface,"  as  the  geologist  would  say. 
The  lateral  are  the  ganglia  of  the  pneumogastric  nerves  (ganglia  resti- 
formia).  We  have  seen  them  in.  the  Yertebrata  generally,  and  more 


Medulla  oblongata.  s.  Olivary 
ganglion.  T.  Pyramidal  eminence, 
w.  The  restiforrn  body  to  the  outer  side 
of  the  last-mentioned. 


182 


HUMAN    BRAIN. 


86-  distinctly  separated  from  the  posterior  in  some  of 

the  more  bulky  Mammalia,  where  the  motor  and 
sensory  columns  are  larger  than  in  man. 

The  posterior  ganglia  are  found  in  the  fissures 
at  the  back  part  of  the  cord,  which  is  known  by 
the  name  of  the  fourth  ventricle  (see  fig.  86). 
They  form  two  projections  of  a  pyramidal  form* 
(see  fig.  78,  F).  In  these  terminate  the  auditory 
or  eighth  pair  of  nerves — posterior  pyramidal 
bodies,  or  auditory  ganglia.  They  have  been 
remarked  in  the  fish  under  the  title  of  tubercles 
of  the  fourth  ventricle. f 

The  arrangement  of  the  cineritious  neurine  in 
the  olivary  bodies  will  be  understood  by  referring 
to  figs.  86  and  87,  where  the  beautiful  contrivance 
which  has  been  adopted  in  the  arrangement  of  the 
cineritious  neurine  in  this  ganglion  is  exhibited. 
A  transverse  section  (fig.  86)  shows  the  neurine 
forming  a  waving  line,  open  internally,  but  pre- 
senting a  convexity  outwards  and  forwards ;  a 
longitudinal  section  (fig.  87)  still  shows  a  waving 
line,  but  the  convexity  outwards,  the  concavity 
inwards.  This  arrangement  is  of  exactly  the 
same  kind  as  that  employed  in  the  hemispherical 
ganglia,  namely,  a  contrivance  by  which  an  ex- 
tensive surface  of  neurine  is  packed  into  the  small- 
est space.  The  cineritious  neurine  of  this  ganglion 
appears,  indeed,  as  if  it  were  crumpled  up  to  ac- 
commodate it  to  its  confined  situation. 

The  olivary  bodies  are  not  isolated  ganglia, 
but,  like  the  rest  of  the  cerebral  ganglia,  more  or 
less  united  ;  they  are  connected,  by  means  of  some 
of  the  longitudinal  fibres  of  the  antero-lateral 
columns,  with  the  cord  below  and  the  brain  above 
(fig.  87,  ot,ot)0t}.  These  fibres  constituting  the 
olivary  columns,  are  on  a  plane  posterior  to  the 
posterior  division  of  the  pyramidal  bodies,  which 
they  come  in  contact  with,  and  then  diverge  from 
them  again.  It  has  been  said  that  in  the  crus  ce- 
rebri  these  olivary  columns  appear  to  divide  into 
two  portions,  the  one  passing  forwards  above  the 

*  Ruysch  describes  the  restiforrn  bodies  under  the  name  of  posterior  pyramidal ;  and 
Rolando  describes  the  internal  lamina  of  the  restiforrn  todies  by  that  name,  and  even  warns 
the  reader  against  confounding  them  with  the  restiibrm  bodies. 

t  Foville  says,  "  The  restiforrn  body  is  incontestably  a  prolongation  of  the  posterior  fascicu- 
lus of  the  spinal  cord.  The  olivary  body,  and  small  filaments  in  the  interval  of  which  it  is 
situated,  are  evidently  continuous  with  the  antero  lateral  columns  of  the  spinal  cord." — P.  312. 
"  The  olivary  eminences  are  but  a  part  of  the  lateral  fasciculus,  containing  in  their  interior 
a  double  festoon  of  yellow  substance.  The  superincumbent  white  layers  which  compose 
the  exterior  of  the  olivary  bodies  may  be  easily  traced  to  the  superior  parts  of  the  lateral 
fasciculus."  This  author  does  riot  propound  any  theory  of  the  probable  office  of  this  gan- 
glion. 


Sections  of  the  medulla  ob- 
longata  at  the  situations  indi- 
cated by  transverse  lines  in 
fig.  85.  F.  Auditory  ganglion 
or  posterior  pyramidal  body. 
G.  Pneumogastric  ganglion, 
s.  Olivary  ganglion.  The  gray 
matter  in  sections  5.  6,  and  7, 
show  the  gradual  deposit  of 
the  anterior  and  posterior 
peaks  of  the  gray  matter  of 
the  spinal  cord. 


STRUCTURE  OF  THE  MEDULLA  OBLONGATA. 


183 


locus  niger,  the  other  ascending  to  the  tuberctila  quadrigemina  and 
thalami  nervi  optici  ;  but  this  description  is  not  physiologically  correct. 
The  greater  part  of  the  olivary  column,  for  reasons  stated  further  on, 
must  be  considered  a  part  of  the  motor  tract. 


Fig.  87. 


The  special  object  of  this  drawing  is  to  show  the  relative  course  of  the  pyramidal  and  olivary  portions 
of  the  motor  tract  through  the  pons  Varolii  and  cms  cerebri,  as  exhibited  by  a  longitudinal  section.  It 
also  shows  a  most  important  point  in  the  anatomy  of  the  medulla  oblongata, — namely,  the  connection  of 
the  motor  root  of  the  fifth  nerve,  we,  with  the  olivary  tract,  c.  Anterior  optic  tubercle  D.  Posterior  ditto. 
E.  Cerebellum.  K.  Optic  thalamus.  M.  Corpus  striatum.  p.  Corpus  callosum.  s.  Olivary  body.  T.  Pyra 
midal  ditto,  x.  Pons  Varolii.  i  &  c.  Inter-cerebral  commissure,  or  processus  6  cerebello  ad  testes. 
b  b.  Optic  nerves,  e.  Third  pair.  /  n.  Locus  m'ger.  m  e.  Motor  root  of  the  fifth  pair,  o  t.  o  t,o  t.  Olivary 
tract,  one  portion  running  up  to  the  optic  tubercles;  another  running  through  the  pons  Varolii.  p  t,  p  t. 
Pyramidal  tract  running  through  the  pons  Varolii,  the  continuation  of  which  through  the  corpus  striatum 
is  marked  m  t. 

The  true  olivary  columns  are  placed  to  the  outer  side  of  the  sensory 
tract.* 

These  olivary  columns  connect  together  the  origins  of  the  third, 
fourth,  and  fifth  pair,  the  auditory  nerves,  pneumogastric,  glosso-pharyn- 
geal,  and  lingual  nerves.  These  extensive  commissural  connections  of 
the  olivary  ganglia  render  my  supposition  regarding  their  office  still  more 
probable.  If  it  is  their  office  to  preside  over  the  movements  of  the 
tongue  as  an  organ  of  speech,  we  can  quite  understand  the  necessity  of 
its  being  closely  connected  with  all  the  ganglia  of  special  sensation. 

Dr.  Todd  considers  "  that  the  olivary  columns  constitute  the  funda- 
mental part  of  the  medulla  oblongata,  that  on  which  its  action  as  a  dis- 
tinct centre  depends." 

Gall  described  this  fasciculus  of  fibres  ascending  from  the  olivary  bo- 
dies through  the  pons  Varolii.  Rolandof  distinctly  denies  that  any  such 
fibres  are  to  be  met  with  ;  at  the  same  time  he  suggests  that  the  fibres 
so  described  are  most  probably  "the  anterior  cords  of  the  medulla  spi- 
nalis,  which  are  compressed,  as  it  were,  between  the  peduncles  of  the 
cerebellum  and  olivary  bodies." 

In  the  sheep,  the  horse,  the  calf,  and  the  cat,  I  find  (see  figs.  52  and 
56)  that  there  is  a  wavy  line  of  gray  matter  in  the  very  centre  of  the 


1847.     I  have  again  and  again  dissected  these  parts,  and  I  am  quite  convinced  of  the 

8. 

Toreno,  1828. 


accuracy  of  my  description,  though  in  opposition  to  some  high  authorities. 
I  Saggio  sopra  la  Vera  Struttura  del  Cervello,  2d  edit.,  vol.  i.  p.  53. 


184  HUMAN    BRAIN. 

corpus  pyramidale,  which  is  clearly  the  analogue  of  the  corpus  olivare 
in  man.  In  the  porpoise,  as  already  mentioned,  this  deposit  of  gray 
matter  holds  the  same  situation,  only  that  it  forms  a  projection  on  the 
surface,  which  it  does  not  in  the  horse  and  calf.  In  the  horse  it  is  some 
distance  from  the  pons  Varolii,  and  much  nearer  the  origin  of  the  lingual 
nerve  than  the  pneumogastric.  The  difference  of  its  position  in  the  hu- 
man subject  I  conceive  simply  arises  from  the  difference  in  its  size, 
which  in  man  is  so  great  that  it  is  pushed  upwards  to  the  surface. 

Dr.  John  Reid,*  in  an  interesting  paper,  entitled,  "  On  some  points  in 
the  Anatomy  of  the  Medulla  Oblongata,"  was,  I  believe,  the  first  to 
point  out  that  uthe  olivary  is  a  motor  column."  I  have  carefully  inves- 
tigated this  point  since  my  first  edition  :  I  fully  agree  with  him  ;  also  in 
the  important  fact  that  the  motor  root  of  the  fifth  pair  arises  from  it, 
which  I  made  out,  without  being  aware  that  he  had  previously  disco- 
vered the  same.  The  origin  of  the  motor  or  non-ganglionic  root  of  the 
fifth  pair  of  nerves  has  long  puzzled  anatomists,  and  we  find  a  different 
description  in  most  anatomical  works.  One  of  the  latest  and  more  care- 
fully detailed  is  by  Dr.  B.  Alcock,  of  Dublin,  in  the  Encyclopaedia  of 
Anatomy ;  it  is  too  long  to  extract  as  a  whole.  He  traces  both  roots 
down  to  the  medulla  oblongata,  saying  that  u  having  traversed  the  crus 
cerebelli,  they  are  both  attached  below  and  behind  it  to  the  same  part  as 
the  greater  packet  (the  sensory  division)  and  posterior  to  it."  He  states 
that  there  is  a  slight  eminence  at  the  point  of  junction  of  the  two  roots, 
from  which  two  cords  descend,  "  one  for  each  column  of  the  spinal  mar- 
row," one  portion  into  the  posterior  column,  the  other  into  the  anterior. 
Now  it  appears  to  me  that  Dr.  Alcock  has  traced  the  olivary  column 
down  as  the  motor  root  of  the  nerve.  At  the  same  time  it  should  be 
understood  that  the  above  short  account  does  not  do  justice  to  the  very 
full  and  minute  description  which  Dr.  Alcock  has  given,  and  which  the 
anatomist  should  peruse  for  himself.  In  fig.  87,  the  reader  will  see  the 
connection  of  the  motor  root  of  the  fifth,  as  easiest  displayed  by  dis- 
section. 

The  ganglia  restiformia,  or  the  ganglia  of  the  pneumogastric  nerves, 
which  form  such  a  prominence  in  the  skates  and  some  olher  fishes,  do 
not  form  any  projection  on  the  surface  of  the  medulla  oblongata  of  the 
human  subject.  They  are  covered  by  the  fibres  of  the  corpora  resti- 
formia ;  their  relative  situation,  and  the  anatomical  line  of  demarkation 
between  them  and  the  auditory  ganglia,  may  be  seen  distinctly  in  a  trans- 
verse section  of  the  medulla  oblongata  at  this  part  (fig.  86). 

The  ganglion  restiforme  (G)  I  have  little  doubt  is  an  important  organ 
in  the  function  of  respiration,  for  the  pneumogastric  nerve,  which  both 
terminates  in  it  and  arises  from  it,  like  the  spinal  nerves,  is  a  com- 
pound nerve ;  it  is  a  nerve  of  sensation  in  relation  to  the  sensibility  of 
the  lining  membrane  of  the  respiratory  organs, — the  "besoin  de  respirer" 
is  dependent  upon  it;  it  is  also  a  nerve  of  motion,  in  as  much  as  the 
muscles  of  the  larynx  and  the  muscular  tissue  of  the  trachea,  bronchi, 
and  stomach,  are  under  its  control.  So  far,  then,  the  opinion  of  Mayo, 
referred  to  further  on,  that  nerves  of  sensation  and  motion  supplying  the 

•       •  Edinburgh  Medical  and  Surgical  Journal,  January,  1846,  vol.  Iv.  p.  15. 

•-.;..'  : .  •  •  • 


STRUCTURE  OF  THE  MEDULLA  OBLONGATA.         185 

same  parts  are  connected  with  one  deposit  of  cineritious  neurine  at  their 
central  extremity,  is  confirmed  in  this  instance.  It  is  therefore  highly 
probable  that  the  gray  matter  at  the  posterior  part  of  the  cord  (G)  is  a 
central  point,  from  whence  emanates  that  peculiar  power  which  the  sys- 
tem of  respiratory  nerves  conducts,  and  by  which  they  call  the  respiratory 
muscles  into  action  independently  of  volition'.  In  support  of  the  opinion 
that  the  respiratory  muscles  are  dependent  on  this  portion  of  the  medulla 
oblongata  for  their  stimulus  to  contraction,  the  results  of  two  or  three 
experiments  may  be  related. 

A  section  of  the  spinal  cord  made  above  the  origin  of  the  intercostal 
nerves  simply  annihilates,  as  regards  the  respiratory  movement,  the 
power  of  the  intercostal  muscles.  A  section  above  the  phrenic  nerve 
induces  paralysis  of  the  diaphragm  also;  while  a  section  exactly  at  the 
origin  of  the  par  vagum,  and  therefore  through  the  medulla,  occasions 
a  total  cessation  of  every  respiratory  movement,  and  instant  death.  If 
the  section,  however,  be  made  above  this  point,  then  the  whole  of  the 
respiratory  movements  take  place  as  usual.  Is  it  not,  then,  from  this 
point,  and  this  only,  that  they  draw  their  power  of  motion  ?  A  section 
of  the  par  vagum  produces  no  such  immediate  effect;  the  section  must 
destroy  the  restiform  ganglion  before  total  interruption  to  the  respiratory 
action  can  take  place. 

For  the  proofs  that  the  sensibility  of  the  air-passages  is  dependent  on 
their  connection  with  the  encephalon  through  the  intervention  of  the  par 
vagum,  I  must  refer  my  readers  to  Brachet's*  researches  on  this  interest- 
ing subject.  'f-i  <• 

The  relation  of  the  antero-lateral  and  posterior  columns  of  the  spinal 
cord  to  these  ganglia  of  the  medulla  oblongata,  must  next  be  studied,  as 
this  will  be  the  clearest  method  we  can  adopt  for  arriving  at  a  knowledge 
of  their  connection  with  the  cerebral  mass. 

For  this  purpose  let  the  pia  mater  be  carefully  dissected  off  from  the 
surface  of  one-half  of  the  spinal  cord,  and,  in  so  doing,  all  the  nerves 
on  one  side  may  be  removed  ;  those  on  the  opposite,  however,  being 
sedulously  avoided.  In  removing  this  membrane,  where  dipping  into 
the  anterior  fissure,  as  described  in  the  directions  for  dissecting  the  cord, 
the  student  will  find,  about  an  inch  and  a  half  from  the  pons  Varolii, 
several  medullary  bands  crossing  the  anterior  median  fissure  obliquely 
from  one  side  of  the  cord  to  the  other ;  these  bands  belong  to  the  ante- 
rior columns:  and  this  crossing  of  their  fibres  from  one  side  to  the  other 
is  technically  called  the  decussation  of  the  pyramidal  bodies  (see  fig.  85). 

This  fact  of  the  decussation  of  the  anterior  columns  or  motory  tract  of 
the  spinal  cord  is  extremely  important,  and  particularly  interesting  in  a 
pathological  point  of  view,  explaining,  as  it  does,  the  fact,  that  disease 
of  the  right  side  of  the  brain  almost  uniformly  produces  paralysis  of  the 
left  side  of  the  body,  and  vice  versa.  Hippocrates  himself  mentions  the 
fact,  that  lesions  on  one  side  of  the  head  were  often  observed  to  occa- 
sion palsy  on  the  opposite  side  of  the  body ;  but  Aretaeus  was  the  first 
who  attempted  to  explain  it,  by  supposing  a  decussation  of  the  nerves 
at  their  origin  in  the  brain.  Dion  Cassius  is  the  next  who  speaks  of  a 

*  Recherches  Experimentales  sur  les  Fonctions  du  Systeme  Nerveux  Ganglionaire,  par 
J.  L.  Bracket,  1834,  p.  135. 


186  HUMAN   BRAIN. 

decussation  of  the  cerebral  nerves  and  spinal  cord ;  but  with  him  the 
subject  dropped,  and  the  attention  of  the  medical  world  was  only  recalled 
td  the  fact  in  1581,  by  Fabricius  Hildanus.  The  true  decussation  of  the 
pyramidal  bodies,  however,  was  first  described  by  Mistichelli,  in  1709  ; 
it  was  noticed  by  Petit  in  the  year  following,  and  at  a  later  period  by 
Lieutaud,  Santorini,  and  Winslow.  The  same  authors  also  speak  of 
other  decussations,  but  probably  on  mere  supposition. 

"  Modern  anatomists,"  says  Dr.  Spurzheim,  "  before  Dr.  Gall  and 
myself,  were  divided  in  opinion  upon  the  subject  of  decussation.  Many 
admitted  the  fact,  but  no  one  pointed  out  the  place  of  its  existence. 
Vicq  d'Azyr,  for  example,  confounds  the  simple  transverse  fibres  between 
the  two  halves  of  the  spinal  cord  with  the  true  decussation  of  the  pyra- 
midal bodies.  Many  others,  among  the  number  Prochaska,  Barthez, 
Sabatier,  Boyer,  Dumas,  Bichat  and  Chaussier,  have,  in  the  most  posi- 
tive terms,  denied  the  decussation  of  the  pyramidal  bundles  altogether, 
as  we  have  shown  in  our  reply  to  the  Report  of  the  Committee  of  the 
French  Institute  upon  our  Anatomical  Memoir."* 

Rolando  entertains  some  curious  ideas  on  the  subject  of  the  pyramidal 
bodies;  for  he  states,  page  60  of  the  work  referred  to,  that  "  the  pyra- 
midal bodies  must  not  be  considered  as  a  division  of  the  principal  cords 
of  the  spinal  marrow,  since  these  fasciculi  of  medullary  fibres  are  not  in 
any  way  continuous  with  the  fibres  of  the  medulla,  which  it  is  easy  to 
see.  The  fibrous  fasciculi,  and  the  roots,  so  to  speak,  of  the  pyramids, 
begin  on  the  anterior  face  of  the  medulla  spinalis  fourteen  or  sixteen 
lines  below  the  annular  protuberance,  and  the  anterior  columns  run 
behind  them.  It  seems  that  Tiedemann  has  been  led  to  admit  the  con- 
tinuation of  the  pyramids  with  the  anterior  columns,  from  the  decussa- 
tion observed  at  this  point:  however,  the  fact  that  the  fibres  of  the 
pyramids  only  have  their  origin  from  that  point  at  which  the  crossing  is 
perceptible,  forms  a  strong  argument  against  the  received  disposition; 
since  it  is  very  evident  that  if  they  only  arise  from  this  point,  they  cannot 
pass  to  the  opposite,  or  be  continuous  with  the  fibres  of  the  spinal  mar- 
row." In  addition  to  which,  Rolando  states  that  his  observations  on 
the  chick  confirm  his  opinion  that  the  pyramidal  bodies  are  merely  placed 
upon  the  spinal  marrow. 

Burdachf  describes  the  pyramidal  bodies  as  consisting  of  fundamental 
and  decussating  fibres;  the  fundamental  fibres  he  derives  from  t\\z  floor 
of  the  anterior  median  fissure  :  in  this  particular  he  appears  to  me  in  error, 
and  for  this  simple  reason — the  floor  of  the  median  fissure,  as  I  have 
already  stated,  is  formed  by  transverse  commissural  fibres,  and  the  supe- 
rior edge  of  this  commissure  of  the  cord  is  distinct  immediately  below 
the  point  of  decussation,  but  without  any  fibres  to  be  seen  ascending 
from  it. 

Burdach,  however,  is  perfectly  right  in  describing  certain  fibres  of  the 
anterior  columns,  which  form  the  edge  of  the  anterior  median  fissure, 
and  enter  into  the  composition  of  the  pyramidal  bodies,  as  continuing 
the  course  along  the  same  side  of  that  fissure  without  crossing  it.f  , 

*  See  Spurzheim's  Anatomy,  p.  147. 

t  Vom  Baue  und  Leben  des  Gehirns.     Leipsic,  1822,  vol.  ii.  p.  31. 

j  Cruveilhier,  who  admits  the  decussation  of  the  pyramidal  bodies,  nevertheless  denies 


PYRAMIDAL   BODIES.  187 

The  decussating  fibres  of  the  pyramidal  bodies  are  derived  from  the 
antero-lateral  columns  behind  the  anterior  roots  of  the  spinal  nerves,  and 
in  front  of  the  posterior  peaks  of  gray  matter.  Ascending  from  this  posi- 
tion in  the  cord  towards  the  mesial  line  to  decussate  with  their  fellows 
on  the  opposite  side,  they  pass  to  the  inner  side  of  the  main  portion  of 
the  anterior  columns,  which  here  retreat  from  the  mesial  line  to  make 
way  for  them.  The  lateral  columns,  then,  in  passing  from  the  posterior 
and  outer  side  of  the  cord  towards  the  inner,  are  overlaid  by  certain  fibres 
of  the  anterior  columns.  Some  of  these  fibres  of  the  anterior  columns 
ascend  like  those  of  the  pyramidal  bodies  through  the  pons  Varolii  to  the 
cerebrum  ;  but  encountering  the  olivary  bodies  in  their  way,  they  are 
split  by  them,  and,  forming  an  envelop  for  them,  have  been  called  by 
Burdach,  Hullenstrange,  or  envelop,  or  shell  cords.  Other  fibres  from 
the  anterior  columns,  which  will  be  more  minutely  described  elsewhere, 
run  up  to  the  cerebellum. 

There  are,  it  is  true,  a  few  cases  on  record,  in  which  no  decussation 
of  the  pyramidal  bodies  has  been  discovered;  but  such  cases  must  be 
viewed  as  exceptions  to  a  general  rule.  Let  the  student,  then,  distinctly 
understand,  that  the  pyramidal  figure,  which  appears  drawn,  as  it  were, 
on  the  anterior  surface  of  the  cord,  and  gives  rise  to  the  term  corpus 
pyramidale,  is  simply  caused  by  the  crossing  over  of  the  constituent 
fibres  of  the  antero-lateral  columns  from  one  side  to  the  other;  that  it  is 
not  occasioned,  as  is  the  projection  of  the  corpus  olivare,  by  the  addition 
of  fresh  masses  of  either  cineritious  or  medullary  neurine,  as  supposed  by 
Rolando.  Though  the  term  pyramidal  body  is  objectionable,  as  implying 
the  existence  of  an  independent  or  distinct  structure,  nevertheless,  as 
the  term  has  been  so  long  sanctioned,  we  must  continue  to  employ  it, 
at  the  same  time  considering  it  merely  an  appearance  necessarily  pro- 
duced by  the  oblique  overlaying  of  certain  constituent  fibres  of  the  cord. 

The  decussating  fibres  of  the  spinal  cord  are  therefore  not  merely  the 
fibres  of  the  anterior  columns,  but  also  those  of  the  lateral  columns:  the 
posterior  surface  of  these  decussating  fibres  may  be  seen  from  behind  by 
separating  the  sides  of  the  posterior  median  fissure;  and  I  cannot  help 
thinking  that  it  must  have  been  this  view  of  the  decussation  of  the  pyra- 
midal bodies  which  Sir  Charles  Bell  mistook  for  a  true  decussation  of  the 
posterior  columns.  For  I  have  looked  frequently,  but  in  vain,  for  any 
such  decussation  of  the  posterior  columns. 

A  view  of  the  section  of  the  cord  at  this  point  will,  I  think,  be  found 
very  interesting,  .as  showing  the  relation  of  the  decussating  fibres  to  the 
gray  matter  (see  Nos.  5  and  6,  figs.  85  and  86). 

Line  of  Demarkation  between  the  Tracts  of  Sensation  and  Motion. — 
Although  the  different  offices  performed  by  the  anterior  and  posterior 
roots  of  the  spinal  nerves  have  been,  I  think,  clearly  ascertained,  and  as 
it  is  also  evident  that  the  spinal  cord  consists  of  tracts  of  neurine  whose 
office  is  the  same  as  the  nerves  which  are  connected  with  them,  and 
therefore  that  there  are  portions  of  the  cord  which  perform  functions  as 
distinct  from  each  other  as  the  arteries  and  veins,  still  anatomists  are  not 
yet  agreed  as  to  the  line  of  demarkation  between  them.  Sir  Charles  Bell, 

that  they  are  continuous  with  the  anterior  columns.     P.  594,  t.  iv.,  he  says,  "  Que  les  pyra- 
mides  anterieures  ne  sont  en  aucune  facons  continues  aux  cordons  ant£rieures  de  la  Moelle." 


188 


HUMAN    BRAIN. 


Fig.  88. 


for  instance,  in  a  paper  published  in  the  135th  vol.  of  the  Philosophical 
Transactions,  states  that  he  regards  the  lateral  portion  of  the  antero- 
lateral  columns  as  a  part  of  the  tract  for  sensation,  and  I  have  no  doubt 
of  its  correctness.  The  circumstance  of  there  being  no  decided  anato- 
mical line  of  division  between  the  two  columns,  is  not  of  itself  an  argu- 
ment against  the  correctness  of  this  view  ;  for  it  is  quite  possible  that 
perfect  distinctness  of  parts,  as  regards  their  function,  without  any  visible 
line  of  separation  between  them,  may  exist.  We  must  always  bear  in 
mind  that  the  neurine  which  composes  the  cord,  is  supported  and  clothed 
by  a  perfect  though  delicate  membrane,  which,  pervading  its  substance 
in  every  direction,  is  undoubtedly  as  capable  of  separating  masses  of 
neurine  endowed  with  distinct  powers,  and  ordained  by  nature  to  execute 
distinct  offices  from  each  other,  as  any  fissure,  however  wide,  or  mem- 
brane, however  thick.  The  presence  of  such  gross  and  palpable  parti- 
tions, it  is  true,  would  save  us  some  trouble  in  discovering  the  line  of 
deraarkation,  but  would  not  necessarily  make  it  in  any  way  more  efficient. 
They  are  not  the  less  distinct  organs  because  of  our  ignorance  of  their 
respective  limits,  any  more  thagi  a  nerve  of  motion  is  one  of  sensation 
because  we  are  incapable  of  unraveling  the  fibres  of  each  from  their 
common  investing  membrane. 

That  the   boundary  line  between  the   two   organs  of  sensation  and 
voluntary  motion  comprised  within  the  spinal  cord  cannot  be  formed  by 

the  posterior  peak  of  gray  matter,  is  very  de- 
cidedly proved  by  the  fact  that  a  portion  of 
the  fifth  pair  of  nerves,  which  we  know  to 
be  a  nerve  of  sensation  from  the  beautiful  ex- 
periments of  Mayo  and  Sir  Charles  Bell,  is 
not  connected  with  the  posterior,  but  with 
the  lateral  columns.  This  is  seen  in  fig.  94. 
Some  have  supposed  that  the  olivary  bo- 
dies divide  the  motor  from  the  sensory  co- 
lumns ;  but  we  have  seen  in  the  medulla  of 
the  horse,  &c.,  that  the  position  of  the  above 
ganglion  varies,  and  is  accidental  :  in  some 
actually  imbedded  in  the  pyramidal  tracts. 
In  the  human  subject  we  often  find  the  fibres 
of  the  anterior  columns  diverging  at  these 
bodies,  and  meeting  below  them,  as  will  be 
seen  in  fig.  88. 

The  antero-lateral  columns  within  the  spi- 
nal canal  consist  of  fibres,  which  simply  lie 
parallel  to  each  other  without  interlacing  like 
the  filaments  of  a  nerve  ;  so  that  if  a  portion 
of  the  cord  (previously  hardened  in  alcohol) 

This  drawing  exhibits  an  unusual,       ,  .*,         r         *          •  .         ,.  •  .  i 

hut   instructive,   separation    of  the       be    taken    in    the    tOTCepS,  it  Splits  Up  WltnOUC 

any  difficulty,  and  the  fibres  themselves  do 

»«>'  aPPear  to  .be  to[»'  bu'  •""fly  the  ««"»• 

brane     Connecting     them.       ll     thlS     mOUC     Ot 
fibres  of  the  anterior  columns  seen  ..  ,  ,  I  t\ 

x.  Pons  Varoiii.     proceeding,   however,  be   attempted  on  the 
medulla  oblongata,  we  find,  that  the  fibres, 


form  body,  some  of  the   cerebellar 
fibres  of  the  ant 

on  the  surface, 

turued 


CEREBELLAR    FIBRES    OF    THE    SPINAL    CORD. 

no  longer  maintaining  an  even  parallel  course,  easily  break  off;  and 
great  care,  therefore,  is  required  to  trace  them  to  their  destination,  for 
some  begin  to  take  one  course  and  some  another. 

Before  attempting  to  dissect  them,  the  student  had  better  digest  the 
following  outline  of  their  course  and  destination.  Each  lateral  half  of 
the  spinal  cord  consists  of  a  posterior  column  and  an  antero-lateral  co- 
lumn. The  antero-lateral  column  is  divisible,  physiologically,  into  two 
portions,  the  anterior  half  of  the  cord  or  two-thirds  of  the  antero-lateral 
column  forming  the  motor  tract,  the  posterior  third  of  the  antero-lateral 
column  being  half  of  the  sensory  tract. 

The  anterior  or  motor  tract  is  anatomically  further  divisible,  viz.,  into 
two  columns,  fhe  pyramidal  and  olivary.  Both  of  these  give  fibres  to 
the  cerebrum  and  cerebellum. 

Besides  these  fibres  of  the  antero-lateral  columns,  which  may  be  de- 
scribed under  the  title  of  cerebral  and  cerebellar  fibres  of  the  anterior  or 
motory  columns,  there  is  another  set  which,  in  the  spinal  cord,  occupies 
a  completely  lateral  position,  being  separated  from  the  posterior  columns 
by  the  posterior  peaks  of  gray  matter.  These  were  regarded  by  Sir 
Charles  Bell  as  the  cerebral  strands  of  sensation;  cerebral,  because,  as 
will  be  explained  a  little  further  on,  they  terminate  in  the  cerebrum  ;  of 
sensation,  because  the  posterior  roots  of  the  spinal  nerves  are  connected 
with  them. 

All  the  fibres  of  the  posterior  columns,  or  those  columns  which  are 
separated  from  the  rest  of  the  cord  by  the  posterior  peaks  of  cineritious 
neurine  and  the  groove  of  the'posterior  roots  of  the  spinal  nerves,  take 
their  course  directly  to  the  cerebellum  ;  none  of  them  whatever  can 
be  traced  to  the  cerebrum.  Both  these  portions  of  the  sensory  tract 
will  be  traced  to  the  cerebrum  after  the  description  of  the  course  of  the 
anterior  columns  is  concluded. 

Let  us  first  follow  the  fibres  of  the  spinal  cord  which  go  to  the  cere- 
bellum. Of  the  fibres  which  run  from  the  antero-lateral  columns  to  the 
cerebellum,  there  are  evidently  two  sets,  one  superficial  and  one  deep. 

The  superficial,  which  may  again  be  divided  into  two  sets,  are  de- 
rived from  the  pyramidal  columns,  the  deep  from  the  olivary  columns. 
The  former  cross  the  surface  of  the  cord  immediately  below  the  corpus 
olivare,  and  may  generally  be  seen  without  dissection  ;  they  are  more 
distinct  in  the  sheep,  bullock,  and  horse,  than  in  man,  in  whom  they 
form  a  very  thin  layer  emanating  from  the  corpora  pyramidalia,  and  I 
have  no  doubt  that  they  actually  decussate  with  their  fellows  of  the  op- 
posite side,  forming  in  fact  part  of  the  apparatus  of  decussation,  though 
I  have  not  yet  positively  ascertained  the  fact. 

The  second  of  the  superficial  set  of  fibres  take  the  same  direction  : 
only,  instead  of  crossing  the  cord  immediately  below  the  corpus  olivare, 
they  run  to  the  inner  side  of  the  corpus  olivare,  and  then  ascending  to 
the  cerebellum,  they  form  the  outer  part  of  the  corpus  restiforme. 

The  deep  set  of  fibres  from  the  antero-lateral  columns  to  the  cerebel- 
lum, are  the  most  posterior  of  the  whole  mass  of  fibres  composing  this 
portion  of  the  spinal  cord.  They  are  separated  from  the  posterior  co- 
lumns by  the  posterior  fissure,  from  which  the  posterior  roots  of  the 


190 


HUMAN    BRAIN. 


spinal  nerves  emerge  ;  this  fissure  they  cross  in  their  passage  to  the 
cerebellum,  obliterating  it  entirely. 


Fig.  89. 


Fig.  90. 


Fig.  89. — This  figure  exhibits  those  fibres  from  the  anterior  columns  which,  ascending  to  the  cerebel- 
lum, connect  the  motor  tract  with  that  portion  of  the  cerebral  mass.  E.  Cerebellum,  x.  Pons  Varolii. 
T.  Pyramidal  eminences,  s.  Olivary  bodies,  w  w.  Corpus  resti forme,  its  surface  having  been  carefully 
scraped,  in  order  to  show  the  superficial  cerebellar  fibres  of  the  anterior  columns.  They'ure  represented 
rather  more  distinct  and  thick  than  they  really  appear,  though  their  course,  direction,  and  relation  to 
the  olivary  body,  are  faithfully  given. 

Fig.  90  displays  a  deeper  view  of  the  same  fibres,  and  the  connection  of  the  sensory  root  of  the  fifth 
pair  of  nerves  with  the  lateral  portions  of  the  spinal  cord,  and  the  passage  of  this  root  behind  the  cerebel- 
lar fibres  of  the  anterior  columns,  w  w.  The  corpus  olivare  having  been  raised,  those  fibres  which  run 
behind  that  body  are  exposed.  The  figures  are  the  same  as  the  last,  with  the  exception  of  s  e,  designat- 
ing the  sensory  root  of  the  fifth  pair  of  nerves,  and  p,  which  designates  the  fibres  from  the  posterior  co- 
lumn forming  part  of  the  restiform  bodies,  or  processus  6  cerebello  ad  medullam  oblongatam. 

Thus  it  will  be  perceived  that  one  portion  of  the  antero-lateral  co- 
lumns— for  there  is  yet  another  portion  of  these  columns  to  be  described 
— on  reaching  to  within  a  small  distance  of  the  corpus  olivare,  splits 
into  three  sets  of  fibres :  one,  the  most  anterior,  which  passes  through 
the  pons  Varolii,  as  will  be  described  presently,  may  be  designated  the 
cerebral  fibres  of  the  anterior  columns  ;  a  second  set,  which  may  be  en- 
titled the  superficial  cerebellar  fibres  of  the  anterior  columns,  passing 
over  the  surface  of  the  medulla  oblongata,  are  usually  seen  without  dis- 
section. 


CEREBELLAR   FIBRES   OF   THE   ANTERIOR   COLUMNS.  191 

Rolando*  describes  the  superficial  cerebellar  fibres  of  the  anterior 
columns,  those  which  are  seen  without  dissection,  (the  processes  arci- 
fonnes  of  Santorini,)  under  the  name  of  "  filamenti  arciformi,"  saying,  u  I 
believe  that  I  ought  to  give  such  a  name  to  numerous  filaments  which 
are  seen  to  issue  from  the  transverse  fibres  of  the  annular  protuberance 
precisely  at  the  same  spot  where  the  anterior  cords  penetrate  into  its 
cejntre.  The  filamenti  arciformi  nevertheless  descend  and  partly  cover 
the  above-mentioned  cords,  expanding  on  the  corpora  olivaria,  and  ex- 
tending even  to  the  median  fissure,  by  which  they  remain  separated  from 
each  other.  Such  a  disposition  is  constantly  observable  in  quadrupeds, 
in  which  the  said  filaments  are  extremely  distinct,  although  no  mention 
has  hitherto  been  made  of  them."  Rolando  does  not,  however,  trace 
them,  as  he  might  have  done,  to  the  cerebellum  instead  of  describing 
them  as  descending  from  the  pons  Varolii. 

The  third  or  deep  cerebellar  fibres  of  the  antero-lateral  columns,  pro- 
ceeding in  company  with  those  of  the  posterior  columns,  form  about  a 
fourth  part  of  the  whole  diameter  of  the  restiform  bodies. 

From  the  above  description  it  will  be  remarked  that  the  anterior 
columns  of  the  cord,  which  have  hitherto  been  spoken  of  as  simply 
passing  up  through  the  pons  Varolii  or  commissure  of  the  cerebellum,  to 
be  connected  with  the  cerebrum,!  are  described  as  passing  also  to  the 
cerebellum.  In  a  paper  which  was  read  before  the  Royal  Society  in  May 
1836,  and  published  in  their  Transactions,  part  2d,  for  1836,  1  proved 
that  they  were  connected  with  the  cerebellum  as  well  as  with  the  cere- 
brum, as  allowed  by  Mr.  Mayo  and  Mr.  Owen,  to  whom  my  prepara- 
tions were  referred.  Since  that  time  I  have  had  the  opportunity  of 
showing  the  same  preparations  to  many  of  the  first  anatomical  teachers 
in  England,  who  consider  the  point  fully  established.  They  are  now 
deposited  in  the  Museum  of  the  College  of  Surgeons.  The  corpora 
restiformia,  or  the  processuse  cerebello  ad  medullam  oblongatam,  are  not 
therefore,  as  they  have  usually  been  described,  bodies  which  are  formed 
solely  by  the  posterior  columns:  nor  are  they  bodies  which  consist  of 
fibres  from  the  posterior  columns,  to  which  some  fibres  from  the  anterior 
columns  are  added,  the  additional  fibres  lying  perfectly  parallel  to  those 
of  the  posterior  columns  ;  but  they  are  bodies  which  consist  of  fibres 
that  interlace  in  rather  an  intricate  manner,  the  interlacing  fibres  consist- 
ing of  some  from  the  antero-lateral  and  some  from  the  posterior  columns. 

It  is  rather  curious  that  Rolando  should  have  approached  so  nearly  to 
the  discovery  of  the  fibres  above  described,  as  connecting  the  anterior 

*  Op.  cit.,  vol.  i.  p.  147. 

•{•  Meckel  speaks  of  the  anterior  columns,  as  dividing  into  two  halves,  an  anterior  and 
posterior;  these  he  describes  as  running  up  to  the  inner  side  of  the  corpora  olivaria,  on  a 
plane  with  the  fourth  ventricle.  Besides  which,  he  states  that  a  smaller  fasciculus,  which 
Gall  describes  as  being  occasionally  absent,  after  touching  the  above  bodies,  ascends  to  the 
corpora  quadrigemina.  Mr.  Mayo  is  almost  the  only  author  who  points  out  the  fact,  that  the 
restiform  bodies  are  not  alone  formed  by  the  posterior  columns,  though  the  exact  course  of 
the  additional  fibres  he  was  not  aware  of,  for  he  describes  the  superficial  fibres  spoken  of 
above,  as  descending  instead  of  ascending.  In  his  second  edition  of  his  Outlines  of  Physi- 
ology, p.  273,  he  says,  "On  cutting  through  and  stripping  down  the  corpus  restiforme,  it  is 
found  to  carry  with  it  the  posterior  lateral  furrow;  the  anterior  lateral  furrow  terminates 
among  fasciculi  which  are  continuous  with  the  corpus  olivare."  The  observations  he  omitted 
in  his  3d  edition. 


192  HUMAN    BRAIN. 

columns  with  the  cerebellum,  and  yet  have  just  fallen  short  of  under- 
standing them,  as  is  even  more  evident  by  the  further  perusal  of  other 
passages  in  his  writings;  for  at  p.  142  he  remarks:  "  All  anatomists 
agree  in  saying  that  the  posterior  surface  of  the  olivary  body  is  in  con- 
tact with  the  superior  surface  of  the  peduncles  of  the  cerebellum.  Ma- 
lacarne  observes,  however,  that  they  are  separated  from  them  by  means 
of  a  medullary  layer  of  the  shape  of  a  half-moon.  To  my  thinking,  this 
question  has  been  too  superficially  examined.  No  anatomists  who  have 
especially  studied  the  brain  have  detected  that  between  the  said  olivary 
bodies  and  the  inferior  peduncles  of  the  cerebellum  are  placed  fasciculi 
of  medullary  fibres  which  are  continuations  of  the  anterior  cords  of  the 
medulla  spinalis.  This  omission  appears  to  me  to  have  arisen  from  their 
not  having  paid  sufficient  attention  to  the  direction  of  the  fibres  and  fila- 
ments of  which  these  are  composed.  If  the  anterior  cords  of  the  medulla 
spinalis  be  carefully  examined  a  little  below  the  pyramids,  we  see  that 
they  send  fibres  from  the  anterior  median  fissure  to  the  posterior  lateral 
fissure,  which  forms  the  line  behind  which  issue  the  posterior  roots  of 
the  spinal  nerves,  and  as  the  said  columns  advance  upwards,  they  contract. 
The  fibres  that  were  previously  expanded  become  convergent,  and  are 
found  compressed  between  the  pyramidal  bodies  and  the  cineritious 
tubercles;*  and  following  them  upwards,  they  are  found  strongly  com- 
pressed, and,  as  it  were,  hidden  between  the  corpora  olivaria  and  the 
inferior  peduncles  of  the  cerebellum,  on  which  account  they  have  eluded 
the  minute  investigations  of  anatomists  among  these  parts.  For  in  order 
to  see  these  fibrous  cords  distinctly,  which  are  flattened  externally  and  at 
the  same  time  a  little  curved,  it  is  necessary  to  separate  the  olivary  bodies 
from  the  inferior  peduncles  of  the  cerebellum:  in  this  place  they  are 
covered  by  the  arciform  filaments,  to  be  spoken  of  shortly.  Then,  above 
this  point,  if  you  wish  to  follow  the  fibres  of  the  said  cords  downwards, 
it  is  easy  to  see  that  anteriorly  they  are  directed  towards  the  inferior  ex- 
tremities of  the  olivary  bodies  and  the  pyramids,  in  order  to  form  that 
portion  of  the  medulla  spinalis  which  folds  into  the  anterior  median 
fissure;  whilst  these  find  themselves  in  contact  with  the  inferior  pedun- 
cles of  the  cerebellum  they  bend  backwards,  carry  themselves  towards 
the  posterior  surface  of  the  cineritious  tubercles,  and  go  to  form  the 
posterior  lateral  fissure.  It  is  more  difficult  to  follow  the  anterior 
cords  towards  the  superior  region  of  the  medulla  oblongata"  At  this 
point  his  observation  has  failed  him,  for  instead  of  tracing  them,  as  he 
might  have  done,  to  the  cerebellum,  he.goes  on  to  say :  u  But  one  may  often 
succeed  in  seeing  them  when  they  bend  over  the  superior  extremity  of 
the  olivary  bodies,  where  is  formed  that  space  which  Malacarne  has  called 
the  fossa  quadrilatera.  Nevertheless,  it  is  only  by  means  of  transverse 
sections,  made  and  repeated  at  like  distances,  that  the  anatomist  will 
obtain  an  exact  idea  of  their  arrangement  at  the  part  in  question  ;  in  this 
manner  they  may  get  behind  the  above-mentioned  cords,  although  hidden 
in  the  cineritious  substance  of  the  annular  protuberance."! 

The  best  method  of  dissecting  the  medulla  oblongata,  with  a  view  of 
demonstrating  clearly  the   existence  of  those  fibres  which  connect  the 

*  The  cineritious  tubercles  are  described  as  bodies  situated  on  the  lower  part  of  the  resti- 
form  bodies. 

f  Op.  cit.,  p.  149. 


FUNCTION  OF  THE  CEREBELLUM.  193 

anterior  columns  with  the  cerebellum,  is,  either  to  split  the  posterior 
column  from  the  antero-lateral  column,  by  raising  only  the  posterior 
columns,  or,  in  other  words,  that  portion  which  is  between  the  posterior 
lateral  and  posterior  median  fissure,  about  two  inches  below  the  pons 
Varolii ;  and  drawing  the  portion  thus  separated  very  carefully  up  to- 
wards the  cerebellum,  the  dissector  will  find  that  the  splitting  will  be 
stopped  before  the  cerebellum  is  reached  by  the  superficial  cerebellar 
fibres  of  the  anterior  columns,  unless  so  much  force  is  used  that  the 
superficial  fibres  are  torn  through  without  observation.  Or  another  mode 
of  dissecting  them  is  to  trace  the  sensory  root  of  the  fifth  pair  of  cerebral 
nerves  through  the  pons  Varolii,  down  to  its  connection  with  the  posterior 
portion  of  the  antero-lateral  column,  in  doing  which  a  layer  of  fibres  will 
be  met  with  in  the  medulla  oblongata  about  the  thickness  of  hogs'  bristles, 
running  from  beneath  the  olivary  bodies  on  the  outer  side  of  the  above- 
mentioned  root  of  the  fifth  pair  of  nerves,  to  the  cerebellum,  forming  a 
portion  of  the  restiform  body  in  their  progress  (fig.  90,  w  w). 

The  first  set  of  superficial  cerebellar  fibres  are  represented  (fig.  89, 
w  w)  passing  upon  the  surface  of  the  corpus  restiforme.  The  second,  or 
deep,  set  of  the  cerebellar  fibres  are  represented  cut  through  in  their 
passage  to  the  cerebellum,  just  as  they  cross  the  sensory  tract  of  the  fifth 
pair  (fig.  90,  w  w). 

The  fibres  just  described  as  connecting  the  antero-lateral  columns  of 
the  cord  with  the  cerebellum,  are  peculiarly  interesting  when  viewed  in 
relation  to  the  functions  of  the  cerebellum.  For  although  it  is  true  that 
its  functions  have  not  yet  been  clearly  ascertained,  the  experiments  of 
Flourens,  Bouillaud,  Magendie,  and  others,  and  the  numerous  cases  on 
record  in  which  disease  of  the  cerebellum  has  been  followed  by  paralysis, 
all  tend  to  prove  that  the  cerebellum  is  in  some  way  or  other  connected 
with  the  regulation  of  muscular  action,  most  probably,  as  before  hinted 
at,  that  it  has  the  power  of  combining  the  action  of  individual  muscles 
so  as  to  effect  an  harmonious  result,  such  as  is  necessary  to  enable  us  to 
stand,  walk,  &c.  Even  Broussais,  in  his  lecture  on  Phrenology,  published 
in  the  Lancet,  July  30th,  1836,  acknowledges  that  the  cerebellum  is  an 
instrument  connected  in  some  degree  with  the  combined  action  of  the 
muscles,  though  merely  in  relation  to  the  act  of  copulation.  Their  pre- 
sence also  proves  the  weakness  of  Mr.  Walker's  theory  of  the  function 
of  the  posterior  columns,  as  derived  from  the  supposed  fact  that  the  pos- 
terior columns  alone  are  connected  with  the  cerebellum. 

This  circumstance  is  also  at  variance  with  the  opinions  of  M.  Foville, 
who  reasons  that  the  cerebellum  must  be  concerned  in  the  phenomena 
of  sensation,  because  the  posterior  columns  are  alone  connected  with  it;* 
while  Dr.  Prichard,in  his  treatise  on  Insanity,  and  other  disorders  of  the 
Mind,  p.  482,  after  speaking  of  Foville's  doctrines,  and  their  foundation 

*  Diet,  de  Med.  et  de  Chirurg.  Prat.,  tome  vii.  p.  202,  art.  EITCEPHALE.  "  Or  nous  voyons 
les  cordons  posterieurs  de  la  moelle,  affectes  a  la  sensibilite,  se  prolonger  dans  le  cervelet; 
les  cordons  anteiieurs,  afTectes  au  mouvement,  s'entrecrosier  dans  les  pyramides,  poursuivre 
apres  cet  entrecroisement  leur  marche  vers  le  cerveau,  dans  1'epaisseur  duquel  ils  pene- 
trent  tres  profondement ;  et  nous  trouvons  ainsi  une  raison  anatomique  de  supposer  que  lo 
cervelet  doit  avoir  £  remplir  un  role  tres-important  dans  les  phenomenes  relatifs  a  la  sensi- 
bilite, tandis  que  le  cerveau  jouirait  d'une  influence  directe  et  centrale  sur  la  production  des 
mouvements  volontaires." 

13 


194 


HUMAN   BRAIN. 


upon  what  he  considers  an  established  fact  in  anatomy,  says,  with  the  usual 
caution  of  such  a  highly-talented  observer:  "  In  the  present  state  of  these 
researches,  it  would  be  a  rash  attempt  to  draw  inferences  with  any  degree 
of  confidence;  but  I  may  be  allowed  to  remark  that  the  general  bearing 
of  facts  seems  to  direct  towards  the  conclusion  that  the  two  great  organs 
inclosed  within  the  skulls  of  vertebrated  animals,  belong  respectively  to 
the  two  principal  functions  of  animal  life,  which  are,  first,  sensation, 
conscious  perception,  and  the  physical  phenomena  related  to  intelligence  ; 
and,  secondly,  those  of  voluntary  motion.  This,  however,  can  only  be 

Fig.  91. 


Tliis  is  from  a  dissection  of  a  brain  which  had  been  hardened  in  spirits  of  wine  It  represents  the 
base  of  the  brain  with  the  course  of  the  fibres  from  the  pyramidal  or  motor  columns,  on  the  left  side  ex- 
posed continuously  from  the  pyramidal  body  (T),  through  the  pons  Varolii  (x),  which  has  been  partly  re- 
moved on  that  side,  forming  (u)  the  under  part  of  the  crus  cerebri,  plunging  to  the  corpus  striatum  (M), 
emerging  (mm  mm)  from  thence,  and  running  forwards,  forwards  and  outwards,  outwards  and  back- 
wards, to  the  whole  extent  of  the  hemispherical  ganglion  (B  B  B).  The  course  of  some  of  the  fibres  of  the 
superior  longitudinal  commissure,  and  also  some  of  the  fibres  of  the  great  commissure,  are  shown.  B  B  B. 
Convoluted  surface  of  the  brain,  or  hemispherical  ganglion.  K.  Thalamus  optici  divided.  L  N,  L  N. 
Anterior  cornua  of  the  lateral  ventricle  separated  by  N,  septum  lucidum.  M  M.  Corpora  striata.  N.  Antfrior 
pillars  of  the  fornix  running  from  the  c  a,  corpora  albicantia.  P  p.  Posterior  extremity  and  under  surface 
of  the  great  transverse  commissure,  or  corpus  callosum.  P  P.  Fibres  continued  to  the  posterior  lobe. 
A  P.  Anterior  extremity  of  ditto,  s.  Corpus  olivare.  T.  Corpus  pyramidale.  v  u.  Crura  cerebri.  w  w 
Corpus  restiforme.  x  X.  Pons  Varolii,  x.  divided  end  of  it,  where  it  enters  the  cerebellum,  a  c. 
Anterior  commissure,  divided  a  little  to  the  right  of  the  mesial  line.  g.  Groove  in  the  corpus  striatum, 
from  which  it  has  been  removed,  e.  Third  pair  of  nerves.  fs£  *.  Fissura  Sylvii.  A  n.  Descending 
fibres  of  the  fornix  over 'the  hippocampal  convolution. 


MOTOR   TRACT.  195 

considered  as  a  probable  opinion.  Such  it  has  long  been  thought  by 
many  physiologists  ;  and  though  the  grounds  on  which  this  conclusions 
rests,  appear  to  be  more  secure  than  they  formerly  were,  the  proof  is  still 
detective. " 

The  anterior  portion  of  the  anterior  columns,  that  which  is  usually 
called  the  corpus  pyramidale  (T,  figs.  72,  85),  may  be  now  traced  through 
the  pons  Varolii ;  but  before  doing  so,  the  student  had  better  make  him- 
self acquainted  with  the  structure  of  the  commissure :  for  this  purpose 
let  him  refer  to  the  description  of  the  commissures. 

If  the  student  pull  upwards  by  means  of  a  scoop  director,  the  inferior 
edge  of  the  pons  Varolii  from  the  anterior  column,  or  corpus  pyramidale , 
he  will  find  it  contracted  as  it  enters  this  commissure  to  a  small,  strong, 
rounded  cord. 

Following  this  cord  behind  (see  fig.  91,  and  description)  the  most 
superficial  fibres  of  the  pons  Varolii,  or  beneath  them  as  he  dissects,  and 
tearing  them  backwards  towards  the  cerebellum,  he  will  soon  find  that 
the  fibres  of  the  anterior  columns  diverge  from  one  another,  and  become 
separated  by  the  transverse  fibres  of  the  commissure  through  which  he 
is  now  tracing  them.  This  is  best  seen  by  fig.  87.  It  is  also  im- 
portant that  he  should  be  aware,  in  performing  the  above  dissection, 
that  these  fibres  from  the  spinal  cord  take  a  curved  direction  through 
the  pons  Varolii,  the  convexity  forwards;  otherwise  he  will  be  liable  to 
tear  them  by  going  too  deep  at  the  central  part  of  their  course,  taking 
them  from  above  to  below. 

The  fibres  thus  traversing  this  body  (for,  as  I  have  mentioned  else- 
where, it  cannot  be  considered  a  mere  apparatus  of  transmission  or 
corn  mis  sure)y  emerge  beyond  it,  and  at  its  upper  edge,  form  the  under 
portion  of  a  structure,  which  has  been  already  noticed  under  the  old 
name  of  crura  cerebri(u),  and  which,  diverging  from  its  fellow  of  the 
opposite  side,  forms  the  outer  and  posterior  boundary  of  the  diamond  or 
lozenge-shaped  space  of  the  base  of  the  brain  (see  fig.  72). 

The  crura  cerebri,  thus  viewed  from  below,  appear  to  be  mere  round 
flattened  cords,  consisting  only  of  fibrous  neurine  derived  from  the  an- 
terior columns.  A  perpendicular  section,  (as  represented  in  fig.  92,  In) 
demonstrates  the  presence  of  some  very  dark  pulpy  neurine;  this  has 
been  called  the  locus  niger ;  I  would  rather  designate  it  the  ganglion  of 
the  third  pair  of  nerves :  for  a  portion  of  the  central  extremity  of  this 
nerve  traverses  this  gray  matter,  and  is  split  by  it  into  five  or  six  fila- 
ments, which  become  connected  with  a  portion  of  the  inter-cerebral 
commissure,  as  described  further  on.  Posterior  to  this  ganglion  are 
more  white  fibres :  these  belong  to  the  posterior  portion  of  the  lateral 
column,  the  sensory  columns  of  Sir  Charles  Bell. 

These  right  and  left  anterior  columns,  in  their  passage  through  the 
pons  Varolii,  are  separated  from  each  other  by  a  peculiar  structure,  first 
described  by  Sir  Charles  Bell,  and  represented  in  the  Philosophical 
Transactions  for  1834,  as  resting  with  its  edge  on  the  commissure  of  the 
cerebellum,  and  extending  its  fibres  directly  backwards,  so  as  to  form  a 
striated  leaf,  separating  the  two  great  longitudinal  tracts  which  pass  be- 
tween the  medulla  oblongata. 

In  making  sections  of  the  pons  Varolii,  it  is  a  curious  fact  that  those 


HUMAN   BRAIN. 

parts,  which  appear  gray  on  a  transverse  section,  are  white  on  a  longi- 
tudinal, and  vice  versa. 

The  next  step  in  the  dissection  is,  to  remove  the  arachnoid  and  pia 
mater  from  the  fissura  Sylvii,  through  which  fissure  the  dissector  may 
insert  his  fingers,  and  raising  the  middle  lobe  tear,  through  its  connec- 
tions with  the  anterior  so  completely  as  to  enable  him  to  turn  it  back 
over  the  posterior.  This  will  expose  a  white  flattened  band  crossing  the 
crus  just  where  the  body  plunges  into  the  cerebrum  (see  fig.  72,  on  the 
left  side)  ;  this  band  is  called  the  tractus  options,  and  is  placed  between 
the  commissure  of  the  optic  nerve,  and  its  cerebral  connections;  let  this 
be  divided,  and  the  handle  of  a  scalpel  or  scoop  of  a  director  be  placed 
on  the  surface  of  the  crus,  and  then  removing  the  neurine  which  over- 
laps the  crus,  the  student  will  be  enabled  to  trace  further  the  motor  tract 
of  fibres  of  the  anterior  column.  By  gradually  removing  the  neurine 
which  still  covers  them,  he  will  expose  some  medullary  fibres  running 
from  before  backwards  ;  these  belong  to  the  great  transverse  commissure 
or  corpus  callosum.  On  removing  these  he  will  come  to  a  large  deposit 
or  bed  (M  M),  if  we  may  so  express  it,  of  cineritious  neurine,  through  which 
the  anterior  columns  pass,  exactly  in  the  same  manner  that  the  sensory 
fibres  of  the  fifth  pair  do  through  the  semilunar  ganglion  already  referred 
to  in  the  sphenoido-teraporal  fossa.  This  collection  of  neurine  is  the 
ganglion  of  the  anterior  columns  or  motory  tract,  and  is  commonly  known 
by  the  name  of  the  corpus  striatum  (MM).  In  all  the  figures  these  letters 
designate  it.  By  gradually  scraping  the  substance  of  this  ganglion  away, 
and  carefully  following  the  white  fibres,  the  exact  course  of  the  motory 
tract  (m,  m,  m,  m]  will  be  exposed.  In  the  course  of  scraping  the  cine- 
ritious neurine  away,  a  rounded  band  of  medullary  neurine  will  be  ex- 
posed, taking  its  course  from  the  circumference  of  the  brain  forwards 
and  inwards :  this  band  is  the  commencement  of  the  anterior  commis- 
sure (ac). 

The  motory  fibres,  which  are  thus  traced  into  the  substance  of  the 
corpus  striatum  or  anterior  cerebral  ganglion  of  the  cord,  spread  as  they 
emerge  from  its  external  edge,  and  pursuing  their  course  in  different 
directions  like  the  rays  of  a  fan,  some  passing  forwards,  others  outwards 
and  others  backwards,  terminate  ultimately  in  the  cineritious  neurine 
composing  the  convoluted  surface  of  the  hemispheres,  the  hemispherical 
ganglia,  fig.  91,  B  B  B. 

When  the  student  has  not  the  opportunity  of  tracing  these  fibres  of  the 
pyramidal  bodies,  or  anterior  columns  of  the  cord,  in  a  brain  hardened 
in  spirit,  he  will  obtain  a  very  good  view  of  their  course,  and  especially 
their  relation  to  the  corpus  striatum,  by  a  perpendicular  section  from  the 
medulla  oblongata  through  the  pons  Varolii,  crus  cerebri,  corpus  striatum, 
and  hemisphere  of  the  brain,  in  the  direction  indicated  by  the  dotted 
line,  A  B,  in  fig.  91.  The  appearance  which  this  section  exhibits  is  re- 
presented in  fig.  92.  This  is  a  useful  section  when  we  examine  the  brain 
for  pathological  investigation;  it  gives  a  continuous  view  of  the  motor 
and  sensory  tract,  and  readily  exposes  any  morbid  appearance  in  its 
course.  Gall  and  Spurzheim  have  given  a  very  beautiful  representation 
of  this  tract,  as  viewed  from  below,  in  their  larger  work  on  the  brain. 
• 


MOTOR   TRACT. 


197 


Cruveilhier*  describes  these  columns  as  passing  through  the  thalami 
nervorum  opticorum  in  addition  to  the  corpora  striata.  The  same  author 
also  refutes  the  opinion  of  Reil,  Gall,  and  Spurzheim,  that  these  fibres 
are  reinforced,  as  it  were,  or  augmented  by  their  passage  through  the 
corpora  striata. 

Fig.  92. 


The  brain  is  laid  on  its  upper  surface,  and  a  section  has  been  made  longitudinally  through  the  medulla 
oblongata,  pons  Varolii,  cerebellum,  anterior  and  posterior  cerebral  ganglia,  fornix  and  corpus  callosum, 
anterior  commissure  and  left  hemisphere  of  the  brain,  in  the  direction  indicated  by  the  dotted  line  in  fig. 
91.  i  &  c.  Inter-cerebral  commissure.  CD.  Optic  tubercles.  E.  Cerebellum  and  corpus  dentatum.  K. 
Optic  thalamus.  M.  Corpus  striatum.  N.  Fornix.  p.  Corpus  callosum.  s.  Olivary  body.  T.  Corpus 
pyramidale.  u.  Crus  cerebri.  x.  Pons  Varolii.  a.  Olfactory  ganglion,  ac.  Anterior  commissure,  o  t. 
Olivary  tract,  p  t.  Pyramidal  tract,  s  t,  s  t.  Sensory  tract. 

Wenzel,  with  his  usual  accurate  minuteness,  enters  into  the  question 
of  the  relation  of  the  cortical  substance  of  the  brain  to  the  white  fibre, 
in  the  following  words  :f — "Utrum  cinerea  substantia  quaB  in  exteriore 
cerebri  ambitu  reperitur,  cum  ilia  ex  qua  partes  in  interiore  cerebro  sitse 
constant,  cohaerent  nee  ne  ?"  He  sums  up  his  observations  as  follows  :J 
— "Substantia  cinerea  interiorum  cerebri  partium,  nominatim  striatorum 
corporum,  et  colliculorum  nervorum  opticorum  nullo  totius  sui  ambitus 
loco,  cum  ea  quaa  ad  exteriorem  cerebri  ambitum  pertinet  substantia 
cinerea  immediata  coherent." 

The  anterior  division  of  the  antero-lateral  columns  of  the  spinal  cord, 
or  the  motory  tract  of  neurine,  has  thus  been  traced  from  the  point  where, 
going  by  the  name  of  corpus  pyramidale,  it  forms  part  of  the  medulla 
oblongata — 1st.  Through  the  pons  Varolii  or  commissure  of  the  cerebel- 
lum ;  2dly.  Forming  the  inferior  part  of  the  crus  cere*bri ;  3dly.  Plung- 
ing into  the  anterior  cerebral  ganglion  or  corpus  striatum  ;  and  4thly, 
and  lastly.  Quitting  this  ganglion  in  order  to  reach  the  hemispherical 
ganglion,  or  the  cineritious  neurine  of  the  convoluted  surface  of  the 
hemispheres.  The  posterior  division  of  the  same  column  has  been 
traced  to  the  cerebellum.  It  now  remains  to  trace  the  middle  divi- 
sion in  its  upward  course  from  the  olivary  bodies  through  the  pons  Va- 
rolii to  the  cerebrum,  forming  in  its  course  connections  with  the  optic 
tubercles  and  thalami. 


*  Op.  cit.,  p.  716. 


t  Op.  cit.,  p.  64. 


Op.  cit.,  p. 


198  HUMAN   BRAIN. 

The  student,  after  he  has  traced  these  fibres  of  the  anterior  columns, 
must  return  to  the  medulla  oblongata,  and  slice  off  the  surface  of  the 
corpus  olivare,  commencing  his  incision  at  the  lower  part  of  this  body 
and  carrying  it  up  through  the  pons  Varolii  into  the  outer  side  of  the 
crus  cerebri:  by  this  section  he  will  first  expose  the  interior  of  the  oli- 
vary bodies  (figs.  87,  92,  s),  surrounded  by  the  fasciculi  of  white  fibres, 
one  set  passing  before  and  one  behind  them.  These  two  fasciculi  re- 
uniting at  the  upper  edge  of  the  olivary  bodies,  pass  through  the  pons 
Varolii  (o  £,  o  £),  on  a  plane  posterior  (deeper  in  the  present  position  of 
the  brain),  to  the  pyramidal  columns;  they  are  separated  from  these 
columns  by  about  a  quarter  of  an  inch  of  the  substance  of  the  pons  Va- 
rolii. Some  of  the  fibres  of  these  fasciculi  of  the  olivary  columns,  viz., 
the  most  anterior,  again  join  the  pyramidal  columns  at  the  upper  edge 
of  the  pons  Varolii,  forming  a  portion  of  the  outer  part  of  the  crus  cere- 
bri. These  fibres  run  partly  behind,  partly  on  the  outside,  partly  through 
the  locus  niger;  they  lie  anterior  and  external  to  the  sensory  tract  of  the 
antero-lateral  columns  described  further  on  (see  fig.  87). 

This  fasciculus  has  been  described  by  Reil*  under  the  title  of  Fillet. 
This  author  describes  them  as  continuous  with  both  the  corpora  olivaria 
and  pyramidalia. 

These  fibres,  as  they  traverse  the  pons  Varolii,  separate  into  two  por- 
tions ;  one  passes  inwards  to  join  its  fellow,  so  as  to  form  a  curvilinear 
stratum  of  fibres  immediately  below  the  optic  tubercles. 

The  other  portion,  described  by  Mayo  as  the  fasciculus  of  the  olivary 
body,  ascends  to  the  crus  cerebri,  and  passes  through  the  locus  niger. 
Sir  C.  Bell  describes  this  fasciculus  as  entirely  emanating  from  the  olivary 
body.  This  description  does  not  altogether  accord  with  my  own  dissec- 
tion :  for  after  many  repeated  and  patient  dissections  of  the  lower  ex- 
tremity of  this  fasciculus,  I  invariably  found  that  most  of  its  fibres  passed 
either  partly  before,  or  partly  behind  ;  the  former  being  frequently  con- 
tinuous with  the  pyramidal  columns,  the  latter  with  the  antero-lateral, 
though  a  portion  of  these  fibres  clearly  run  into  the  olivary  bodies,  as 
may  be  seen  in  fig.  87,  o  t. 

The  most  accurate  mode  of  dissecting  these  fibres,  and  the  least  liable 
to  error,  is  to  make  a  section  of  the  pons  Varolii  and  medulla  oblongata, 
previously  removed  from  the  rest  of  the  brain,  including  a  piece  about  an 
eighth  of  an  inch  in  lateral  width,  or  half  of  the  corpus  pyramidale  and 
corpus  olivare  ;  in  that  way  these  fillets  are  exposed  :  and  then  tearing 
this  piece  downwards,  commencing;  the  rent  in  front  of  the  fillet,  and 
thus  separating  it  from  the  pons  Varolii,  its  fibres  may  be  traced  con- 
tinuous with  the  pyramidal  bodies  and  running  in  front  of  the  olives  ;  a 
second  rent  made  behind  the  fillet  will  separate  it  from  the  portion  of  the 
lateral  columns  which  ascend  to  the  thalarni,  and  show  those  fibres 
which  run  behind  the  olivary  bodies.  Dr.  Reid,  in  his  excellent  paper 
on  the  medulla  oblongata,  (Ed.  Med.  and  Surg.  Journal,  1841,)  de- 
scribes these  olivary  columns;  but  he  does  not  state  that  they  go  through 
the  olivary  bodies,  or  that  there  is  any  connection  between  the  fibres  of 
the  columns  and  the  gray  matter  of  the  olive. 

*  Op.  cit.,  p.  94,  part  ii. 


OLIVARY   COLUMNS.  199 

This  author  points  out  more  clearly,  I  believe,  than  any  one  else,  the 
motor  character  of  this  tract;  and  this  seems  to  confirm  my  view,  that  it 
is  a  portion  of  the  antero-lateral.  I  am,  however,  inclined  to  believe 
that  some  of  these  fibres  are  commissural  between  the  olivary  bodies  and 
the  optic  ganglia;  though  I  do  not  quite  understand,  if  there  is  a  func- 
tional connection  between  the  fibres  and  the  olivary  bodies,  that  they  do 
not  stream  through  the  vesicular  neurine  as  the  motor  tract  does  through 
the  corpus  striatum,  &c.  Mayo,  in  his  beautiful  plates  of  the  brain, 
though  he  exhibits  these  columns  (which  he,  like  others,  designates  as 
olivary),  running  round  the  olives,  but  not  through  them,  nevertheless 
speaks  of  them  as  derived  from  them. 

In  the  section  on  Comparative  Anatomy,  I  have  adduced,  I  think,  suffi- 
cient evidence  to  show  that  the  position  of  the  olivary  bodies  varies 
considerably,  and  in  some  animals  they  are  even  imbedded  in  the  pyra- 
midal bodies,  which  goes  far  to  show  the  physiological  identity  of  the 
great  mass  of  the  olivary  and  pyramidal  columns. 

Dr.  Reid  says,  and  I  fully  agree  with  him,  "  If  we  trace  these  olivary 
columns  downwards,  we  observe  that  they  form  attachments  to  the  an- 
terior roots  of  the  first  and  second  cervical  nerves,  and  that  they  continue 
their  course  onwards  in  the  line  of  the  other  anterior  roots  of  the  spinal 
nerves.  We  can,  then,  have  little  difficulty  in  arriving  at  the  conclusion 
that  the  olivary  is  a  motor  column.  On  tracing  this  column  upwards, 
we  find  that  where  it  embraces  the  olivary  body,  the  portio  dura  is  at- 
tached to  its  outer  margin,  and  the  hypoglossal  and  abducens  nerves  are 
partly  attached  to  its  inner  margin,  and  partly  to  the  outer  margin  of  the 
pyramidal  column.  On  tracing  the  two  roots  of  the  fifth  pair,  the  smaller 
or  motor  root  can  be  followed  to  that  portion  of  the  olivary  column  which 
proceeds  to  the  optic  lobes, — sometimes  running  down  the  outer  or  ex- 
ternal edge  of  the  pons,  to  reach  the  portion  of  the  olivary  columns  already 
mentioned  as  it  emerges  from  the  external  margin  of  the  pons;  at  other 
times  its  course  is  observed  by  a  greater  or  less  number  of  the  transverse 
fibres  of  the  pons  crossing  it.  The  trochleator  nerve  is  attached  to  the 
internal  margin  of  the  same  band  of  fibres  when  it  has  ascended  the  pro- 
cessus  e  cerebello  ad  testes,  and  is  about  to  enter  the  optic  lobes. "*  He 
also  describes  the  connection  of  the  portio  dura,  lingual  and  abductor 
nerves  with  the  inferior  portion  of  it. 

The  olivary  column  is  then  a  compound  tract,  commissural  and  nervous. 
The  commissural  portion  emanates  from  the  interior  of  the  olivary  bodies, 
(see  fig.  87,)  and  this  I  shall  designate  the  olivary  commissure.  The 
nervous  portion  belongs  to  the  motor  system  of  nerves,  and  is  physiolo- 
gically a  portion  of  the  pyramidal  tract. 

Dr.  Reid  describes,  and  I  think  justly,  the  pyramidal  columns  as  pass- 
ing into  the  middle  columns  after  their  decussation  ;  he  describes  the 
arciform  fibres  as  going  to  join  the  posterior  or  cerebellar  column  as  I 
first  described  them,  but  he  is  in  error  in  attributing  to  Santorini,  Gall 
and  Spurzheim,  Rosenthal  and  Rolando,  a  knowledge  of  the  fact  that 
they  form  a  communication  between  the  anterior  portion  of  the  cord  and 
cerebellum,  which  I  consider  an  important  anatomical  discovery  alone 
due  to  me. 

*  Ed.  Med.  and  Surg.  Journal,  Jan.  1,  1841. 


HUMAN    BRAIN. 


Fig.  93. 


We  must  now  return  to  the  medulla  oblongata  for  the  purpose  of  trac- 
ing those  tracts  of  neurine  which  Sir  Charles  Bell  has  proved  to  be  em- 
ployed in  conducting  sensation.  It  has  been  already  stated  that  in  the 
composition  of  the  spinal  cord  we  can  observe  no  line  of  demarkation  by 
which  the  tract  of  sensation  may  be  distinguished  from  that  of  motion, 
but  that  a  portion  of  the  cord  anterior  to  the  posterior  fissure  is  distinctly 
ascertained  to  be  appropriated  to  this  function  ;  I  shall  assume,  therefore, 
that  the  line  of  demarkation  is  about  the  middle  of  the  lateral  aspect  of 
the  cord,  and  that  the  sensory  column,  or  tract  of  sensation,  consists  of 
two  portions,  the  one  posterior  to  the  fissure  referred  to,  and  conse- 
quently named  the  posterior  column,  the  other  anterior  to  it,  constituting 
part  of  the  antero-lateral  column.  These  two  portions  had  better  be 
traced  separately.  Commencing  with  the  posterior  division,  or,  in  other 
words,  the  posterior  columns,  we  find  them  ascending  to  the  cerebellum, 
and  in  their  course  to  that  mass  forming  a  portion  of  a  body  previously 
noticed  in  describing  the  anterior  columns,  viz.,  the  corpora  restiformia. 
In  their  passage  to  the  cerebellum,  as  a  portion  of  the  constituent  fibres 
of  these  bodies,  they  are  partly  overlapped  by,  arid  partly  interlace  with, 
those  fibres  from  the  anterior  columns  which,  ascending  to  the  cerebel- 
lum, connect  the  motor  or  voluntary  tract  of  the  spinal  cord  with  the 
cerebellum  as  well  as  with  the  cerebrum  ;  and  let  me  again  repeat  that 
the  fibres  which  compose  the  corpora  restiformia  are  not  arranged 

in  the  simple,  regular,  parallel 
manner  in  which  we  find  them 
in  the  body  of  the  cord,  but 
interlace,  forming  rather  an  in- 
tricate plexus. 

The  cerebral  fibres  of  the  sen- 
sory columns. — The  remaining 
portion  of  the  tract  of  sensa- 
tion, or  that  portion  of  the  sen- 
sory column  which,  in  the  spinal 
cord,  is  anterior  to  the  fissure, 
from  which  the  posterior  roots 
of  the  spinal  nerves  emerge, 
and  whose  line  of  demarkation 
from  the  motor  tract  is  about 
the  middle  of  the  lateral  aspect 
of  the  cord,  must  next  be  traced 
to  its  destination.  In  the  first 
place  we  find  it  sending  a  few 
fibres,  like  the  posterior  col- 
umns, to  the  cerebellum;  the 
rest  of  its  fibres  ascend  princi- 
pally to  the  cerebrum. 

The  proof  that  the  columns, 
which  we  are  now  about  to  trace 
to  the  cerebrum,  form  a  portion  of  the  tract  of  sensation,  is  derived  from 
the  fact  that  the  sensory  root  of  the  fifth  pair  of  nerves  arises  from  it,  see 


This  drawing  is  from  a  dissection  made  on  a  piece  o 
brain  which  had  been  hardened  in  spirits.  It  exhibits  the 
course  of  the  sensory  columns  from  the  medulla  oblongata 
to  the  thalamus.  Their  function  I  consider  proved  by  the 
fact  that  the  sensory  root  of  the  fifth  pair  of  nerves  is  con- 
nected with  them.  c.  Anterior  optic  tubercle.  D.  Poste- 
rior ditto.  I  &  c.  Inter-cerebral  commissure,  or  processus 
£  cerebello  ad  testes.  H.  Spinal  cord.  K.  Thalamus  op- 
tici.  M.  Corpus  striatum.  u.  Crus  cerebri.  w.  Corpus 
restiforme.  x  x.  Pons  Varolii.  ft.  Optic  nerve,  c.  Third 
pair,  b  c.  Locus  niger.  p  t.  Pyramidal,  or  motor  tract. 
s  t.  s  t.  s  t.  Sensory  tract, — the  posterior  third  of  the  antero- 
lateral  column,  s  c.  Sensory  root  of  the  fifth  pair  of 
nerves. 


SENSORY   TRACT. 


201 


fig.  93.*  In  the  medulla  oblongata,  the  cerebral  sensory  tracts  lie  in 
contact  with  each  other  in  the  mesial  line.  In  the  fourth  ventricle,  or 
calamus  scriptorius,  they  are  covered  by  the  auditory  ganglia,  or  pos- 
terior pyramidal  bodies.  From  this  part  they  ascend  behind  the  pons 
Varolii,  where  they  form  the  floor  of  the  iter  a  tertio  a  quarto  ventriculo. 
In  this  situation  they  decussate  with  their  corresponding  fibres  on  the 
opposite  side  (see  fig.  94). 

Fig.  94. 


This  figure  I  sketched  from  a  dissection  made  on  the  same  brain  as  that  from  which  fig.  91  had  been 
taken,  and  the  two  may  be  advantageously  compared.  The  whole  of  the  pyramidal  and  olivary  bodies, 
and  their  respective  tracts,  have  been  removed,  and  the  posterior  part  of  the  cord  left.  D  P.  Decussation 
of  the  pj'ramidal  bodies.  D  s.  Decussation  of  the  cerebral  sensory  tract,  or  posterior  third  of  the  antero- 
lateral  column,  i  &  c.  Inter-cerebral  commissure  divided.  K.  Posterior  extremity  of  the  thalamus  nervi 
optici.  K  it.  Divided  end  of  the  same.  g.  Corpus  geniculatum  externum.  u.  Crus  cerebri.  v  u.  Divided 
end  of  the  same,  w  w.  Corpora  restiformia.  c.  Third  pair  of  nerves,  c  a.  Corpora  albicantia.  e  s. 
Sensory  root  of  the  fifth  pair.  I  n  Locus  niger.  s  t.  Cerebral  sensory  tract,  p  v.  Dotted  lines  marking 
the  situation  and  width  of  the  pons  Varolii,  behind  which  the  decussation  takes  place. 

The  presence  of  such  a  decussation  for  the  sensory  tract  has  long  been 
suspected,  as  it  was  proved  to  exist  for  the  motor  tract. 

Sir  Charles  Bell  believed  that  he  had  discovered  it,  but  he  placed  it 
too  low  down,  and,  as  I  have  stated  elsewhere,  in  all  probability  mistook 
the  posterior  surface  of  the  pyramidal  decussation  for  a  distinct  decussa- 
tion. The  best  mode  of  demonstrating  this  interlacement,  is,  first,  to 
separate  the  medulla  oblongSta,  with  the  pons  Varolii,  crura  cerebri,  and 
optic  thalami,  from  the  rest  of  the  brain.  Secondly,  divide  the  pons 
Varolii  anteriorly,  in  a  longitudinal  direction,  through  the  centre  to  the 
depth  of  half  an  inch;  divide  the  pyramidal  decussation;  then  take  the 

*  I  am  delighted  to  find  that  Stilling,  in  his  new  work  on  the  Pons  Varolii,  has  accurately 
figured  all  these  fibres. 


202  HUMAN   BRAIN. 

two  lateral  halves  of  the  cord  and  split  them  upwards,  tearing  through 
the  floor  of  the  fourth  ventricle.  When  the  rent  passes  the  roots  of  the 
auditory  nerve,  fibres,  the  size  of  ordinary  ligature  silk,  may  be  seen 
running  obliquely  across  the  mesial  fissure,  from  one  side  to  the  other, 
decussating  with  their  fellows.  This  decussation  may  also  be  demon- 
strated anteriorly,  as  represented  in  fig.  94,  though  it  requires  more  care 
and  some  dissection.  This  decussation  may  be  seen  in  the  sheep  as 
distinctly  as  in  the  human  brain.  I  have  not  looked  for  it  in  any  other 
animal.* 

After  this  decussation,  on  their  emergence  from  behind  the  pons  Varolii, 
the  fibres  of  the  sensory  tract  form  the  upper  part  of  the  cms  cerebri, 
separated  in  that  body  from  the  motor  tract  by  that  deposit  of  cineritious 
neurine  called  the  locus  niger,  as  previously  mentioned :  the  sensory 
tract,  where  forming  the  upper  layer  of  the  constituent  fibres  of  the  crus 
cerebri,  is  covered  superiorly  by  the  optic  tubercles  and  the  inter-cere- 
bral commissure. 

These  structures  must  be  raised,  in  order  to  expose  its  course  in  this 
situation.  From  this  point  they  plunge  into  their  appropriate  ganglion, 
the  posterior  cerebral  ganglion,  better  known,  as  before  stated,  by  the 
name  of  the  thalamus  nervi  oplici. 

The  course  of  the  fibres  through  the  posterior  cerebral  ganglion  is  not 
so  distinctly  marked  as  that  of  the  motor  tract  through  the  anterior;  for 
here  the  medullary  fibres  are  not  so  decidedly  separated  from  the  cine- 
ritious; the  two  appear  more  intimately  mingled.  From  the  outer  side 
of  the  posterior  cerebral  ganglion,  the  medullary  fibres  issue  forth,  spread- 
ing in  every  direction  until,  meeting  with  the  convoluted  surface  of  the 
brain  or  the  cineritious  neurine  of  the  hemispherical  ganglia,  their  pro- 
gress is  arrested  and  their  course  terminated. 

A  side  view  of  the  course  of  this  tract  through  the  posterior  cerebral 
ganglion,  or  thalamus  nervi  optici,  and  its  expansion  in  the  hemispheres,  is 
well  shown  in  Gall's  large  work. 

The  relation  of  the  motor  and  sensory  columns  of  the  cord,  as  forming 
part  of  the  cerebrum,  with  their  appropriate  ganglia,  is  thus  described 
by  Sir  Charles  Bell  in  his  paper  in  the  Philosophical  Transactions  above 
referred  to:  "The  thalamus  forms  a  nucleus  round  which  the  corpus 
striatum  bends,  and  when  their  respective  layers  of  striaB  make  their  exit 
beyond  these  bodies  to  form  the  great  fan,  or  solar-like  expansion,  into 
the  hemisphere  of  the  cerebrum,  their  rays  mingle  together.  A  rude 
representation  of  these  two  parts  of  the  cerebrum,  as  we  have  traced  them, 
may  be  made  with  the  hands.  If  I  place  my  wrists  together,  parallel, 
and  closing  one  hand,  embrace  it  with  the  other,  I  represent  the  two 

*  Foville  does  not  describe  any  decussation  of  the  posterior  columns,  but  he  figures  this 
decussation,  though,  as  it  appears  to  me,  in  an  exaggerated  manner.  "  Pi.  2  (Foville),  fig. 
4.  F.  Point  of  the  calamus :  from  this  point,  up  to  c',  may  be  observed  the  entre  rroissement 
of  the  two  halves  of  the  medulla  oblongata."  Longet  (vol.  i.  p.  382)  says,  "  We  have  long 
known  that  all  the  fibres  of  the  antero-lateral  columns  of  the  spinal  marrow  are  far  from 
intercrossing  at  the  place  designated  for  the  decussation  of  the  pyramids.  But  in  separating 
the  posterior  median  fissure  of  the  bulb  and  protuberance  just  below  the  tubercula  quadri- 
gemina,  M.  Foville  has  pointed  out  a  superior  interlacement,  which,  without  doubt,  effects  in 
part  a  union  between  those  fibres  of  the  antero-lateral  columns  which  Rolando  described, 
and  Cruveiihier  designated  the  fasciculus  of  reinforcement  of  the  bulb,  or  faisceau  mnome'.1' 


SENSORY   TRACT.  203 

portions  of  one  crus.  The  closed  fist  is  the  thalamus,  and  the  other  is 
the  corpus  striatum.  If  I  then  extend  my  fingers,  interlacing  their  points, 
I  represent  the  final  distribution  of  the  portions  of  the  nervous  matter 
which  are  dedicated  to  sensation  and  volition." 

The  best  mode  of  dissecting  these  parts,  for  the  purpose  of  tracing  the 
sensory  columns,  as  just  described,  and  which  perhaps  will  give  the  most 
correct  ideas  of  their  relative  position  to  the  parts  with  which  they  are 
connected,  is  to  lay  the  brain  upon  its  under  surface,  and  then  to  make 
a  perpendicular  section  through  the  mesial  line,  from  before  to  behind, 
of  the  whole  cerebral  mass.  This  section  will  divide,  it  is  true,  all  the 
transverse  commissures ;  all  those  structures,  in  fact,  which  connect 
together  corresponding  parts  placed  on  opposite  sides  of  the  mesial  line  ; 
consequently,  these  apparatuses  of  union  must  be  studied  in  another 
brain,  should  they  not  have  been  previously  traced  as  suggested  above. 
The  similarity  of  the  parts  exposed  by  this  section  to  those  composing 
the  cerebral  mass  of  the  turtle,  cannot  fail  to  arrest  the  attention  of  the 
student. 

Let  me  remark,  that  though  most  of  the  parts  to  be  observed  in  the 
following  view,  have  been  already  described  under  a  different  aspect,  I 
speak  of  them  again  without  reference  to  the  previous  notice.  Com- 
mencing from  behind,  and  proceeding  forwards,  may  be  observed  (fig. 
100): 

1.  The  medulla  oblongata,  divided  in  the  mesial  line.     Anterior  to 
this,  and  rather  superior  to  it,  is, 

2.  The  pons  Varolii,  or  commissure  of  the  cerebellum.     Above  and 
behind  the  pons  is, 

3.  The  cerebellum,  presenting  that  curious  and  beautiful  appearance 
resulting  from  the  disposition  of  cineritious  and  medullary  neurine,  called 
the  arbor  vitce.     If  the  student  carry  his  eye  along  that  portion  of  the 
medullary  neurine  which  corresponds  to  the  stalk  of  the  tree,  he  will  find 
it  emerging  from  the  cerebellum,  and  turning  up  to  a  little  rounded  body 
about  the  size  of  a  small  pea;  immediately  anterior  to  which  is  another 
of  rather  larger  size :  the  two  together  are, 

4.  The  optic  tubercles,  or  corpora  quadrigemina,  the  posterior  being 
the  testes,  the  anterior  the  nates. 

The  structure  which  has  been  likened  to  the  stalk  of  the  tree,  will  be 
recognized  as  the  commissure  connecting  the  greater  cerebral  mass  to 
the  lesser,  in  other  words,  the  cerebrum  to  the  cerebellum ;  this  is, 

5.  The  inter- cerebral  commissure. 

Beneath  the  optic  tubercles  we  observe,  rising  up,  as  it  were,  from 
the  pons  Varolii,  a  structure  previously  mentioned,  namely, 

6.  The  crus  cerebri.     A  section  of  this  part  shows  it  to  consist  of 
medullary  neurine  above  and  below,  with  cineritious  interposed  between 
the  two.     The  medullary  neurine,  which  is  above  the  cineritious,  is  the 
sensory  tract,  that  below,  the  motor  tract.     The  cineritious  neurine  has 
been  long  known  to  anatomists  by  the  name  of  locus  niger.     Immediately 
in  front  of  the  crus  and  optic  tubercles  is  a  rounded  nodule  of  considera- 
ble size,  being  about  the  same  dimensions  as  the  jpons  Varolii,  called 

7.  The  thalamus  nervi  optici  by  anatomists  of  the  old  school,  the  j90s- 
terior  cerebral  ganglion  of  the  cord  by  more  modern  teachers. 


204 


HUMAN    BRAIN. 


Anterior  to  this  ganglion,  and  partly  overlapping  it,  will  be  observed 
some  fibres,  which,  appearing  to  spring  from  the  under  part  of  the  brain, 
run  backwards  and  upwards ;  these  fibres  form  a  portion  of  a  longitudi- 
nal commissure  or  fornix. 

If  these  fibres  be  removed,  another  rounded  nodule  of  neurine  will 
be  exposed,  which  has  been  already  observed  upon  its  under  surface ; 
this  is, 

8.  The  corpus  striatum,  or  anterior  cerebral  ganglion,  in  front  of  and 
behind  which,  are 

9.  The  hemispheres,  formed  of  the  fibres  of  the  cord,  commissural 
fibres,  and  hemispherical  ganglia. 

The  structure  of  the  hemispherical  ganglia,  or  cortical  substance  of  the 
brain,  may  next  be  examined.  Their  enormous  size  in  the  human  being, 
as  compared  with  those  in  the  lower  animals,  has  been  already  adverted 
to.  The  extent  of  the  convoluted  surface  is  well  seen  in  both  an  hori- 
zontal section  (figs.  77  and  78),  and  perpendicular  section  (fig.  95). 

These  ganglia  do  not  consist  of  one  single  layer  of  cineritious  neurine, 
but  of  three  layers  alternating  with  three  layers  of  medullary  neurine. 
The  distinction  between  some  of  these  layers  may  often  be  seen  with  the 
naked  eye  in  the  posterior  convolutions  in  a  state  of  health.  But  this 
stratification  is  still  more  evident  after  disease.  When  the  cortical  sub- 
stance has  been  long  the  subject  of  chronic  inflammation,  as  in  old  cases 
of  insanity,  it  is  peculiarly  distinct.  In  the  section  on  pathology,  some 
cases  will  be  detailed.  The  white  fibres  may  be  traced  through  these 
layers,  as  we  have  traced  them  through  the  corpus  striatum. 

Fig.  95. 


This  drawing  having  been  taken  from  a  preparation  which  had  been  some  time  in  spirit,  the  uppe 
surface  is  unnaturally  flattened.  It  exhibits  a  transverse  section  of  the  brain  taken  a  little  posterior  tor 
its  centre,  measured  from  before  to  behind.  It  partly  shows  the  enormous  extent  of,  B,  the  hemispherical 
ganglion.  M.  Anterior  cerebral  or  corpus  striatum ;  the  broad  white  line  just  below  the  letter,  dividing 
it  into  two  portions,  is  the  motorJract.  p.  Great  transverse  commissure  x.  Pons  Varolii.  The  great 
depth  of  the  fissura  Sylvii  may  Be  seen  on  both  sides  of  the  brain.  It  is  most  distinct  on  the  right  side  ot 
the  figure  between  the  two  B  B. 

•  -':      .      . 


HEMISPHERICAL    GANGLIA.  205 

To  the  superficial  observer  this  ganglion  appears  to  consist  of  a  single 
layer  of  cineritious  neurine,  A  little  care  is  sufficient  to  enable  us  to  see 
with  the  naked  eye  that  there  are  at  least  two  layers  of  gray  matter  separated 
by  a  white  layer.  This  is  often  most  distinctly  seen  in  a  brain  that  has 
been  in  a  state  of  chronic  inflammation.  It  is  also  more  distinct  in  the 
posterior  than  in  the  anterior  convolutions.  Vicq  d'Azyr  first  pointed 
this  out  in  the  posterior  portion  of  the  brain,  and  Casanvielh  demon- 
strated its  existence  throughout  the  whole.*  M.  Baillarger,  in  1840, 
stated  that,  under  the  microscope,  this  ganglion  will  be  found  to  consist 
of  six  layers,  three  of  gray  alternating  with  three  of  white. 

The  first  going  from  within  to  without,  is  gray  ;  the  second,  white ; 
the  third,  gray  ;  the  fourth,  white;  the  fifth,  gray  ;  and  the  sixth,  white 
(see  fig.  96,  left  half  of  the  drawing). 

Fig.  96.  Fig.  97.  Fig.  98. 


Fig.  96. — Magnified  representation  of  the  cortical  substance  of  the  brain  of  the  sheep.  (Baillarger.) 
The  left  half  is  seen  as  an  opaque  object;  the  right  as  a  transparent  one.  Left  half. — B.  Tubular  neurine 
of  the  hemispheres.  1,  2.  3,  4,  5,  6.  The  six  alternate  layers  of  gray  and  white  neurine.  Right  half. — 
The  white  substance  fooks  dark,  and  the  gray  neurine  light.  The  numbers  the  same. 

Fig.  97. — Convolution  from  the  human  brain,  single  aspect ;  six  alternate  layers. 

Fig.  98. — This  figure  shows  the  passage  of  the  fibres  through  the  layers  of  the  hemispherical  ganglion. 
The  left  half  is  from  the  human  brain ;  the  right  from  the  brain  of  the  pig. 

These  six  layers  can  be  distinctly  made  out  with  the  microscope. 
Under  the  glass,  the  appearance  is  reversed,  the  gray  being  transparent, 
and  the  white  opaque  (see  the  right  side  of  fig.  96). 

This  author  states  that  he  has  examined  the  gray  substance  of  the 
hippocampus,  and  that  he  has  found  it  striatified  like  that  of  the  convolu- 
tions, which  he  considers  a  proof  that  this  is  an  internal  convolution,  as  I 
have  stated  elsewhere. 

The  tubular  fibres  from  the  hemispheres  pass  through  these  three  layers 
of  vesicular  neurine  (see  fig.  98). 

These  fibres,  which  are  very  long  and  numerous  at  the  summit  of  the 
convolutions,  become  shorter  and  more  scanty  at  their  base.  At  the 
bottom  of  the  anfractuosities,  these  fibres  are  so  short  that  in  some  brains 
we  can  separate  them  from  the  cortical  substance  without  rupturing  them. 

Baillarger  asserts  positively  that  the  external  layer  of  the  brain  is  white, 
and  not  gray,  as  has  been  usually  supposed.  This  color  is  most  evi- 
dent in  the  brain  of  infants,  old  people,  the  insane,  and  of  some  animals. 

Mr.  Grainger  informs  me  that  his  own  observations  by  the  microscope 
on  the  cortical  substance,  quite  accord  with  M.  Baillarger. 

Regarding  the  structure  of  the  cortical  substance  in  the  lower  animals, 

*  M6m.  de  1'Acad.  de  M6d.,tom.  viii.  1840. 


206  HUMAN    BRAIN. 

M.  Baillarger  states,  that  in  the  fish  he  observes  no  stratification  of  this 
ganglion.  In  the  class  Amphibia  he  has  only  examined  the  frog,  and 
that  he  has  not  been  able  to  observe  any  stratification  in  this  ganglion. 
In  the  brain  of  the  bird  there  is  only  one  white  line.  He  found  six  in 
the  brain  of  all  the  Mammalia  he  examined. 

Commissures. — In  commencing  this  new  inquiry,  the  student  must 
remember  that  the  commissures  or  apparatuses  of  union  can  only  be 
thoroughly  understood,  and  their  exact  connections  and  relations  appre- 
ciated, after  a  diligent  consideration  of  the  exact  relative  position  of  the 
different  ganglia  which  it  is  the  office  of  these  commissures  to  connect 
together. 

Spurzheim  confines  the  word  commissure  to  designate  structures  which 
connect  corresponding  parts,  and  applies  the  term  instruments  of  com- 
munication to  those  which  connect  different  parts  on  the  same  side;  a 
distinction  which,  as  it  does  not  appear  to  me  to  be  attended  with  any 
advantage,  I  have  taken  the  liberty  of  rejecting. 

Let  the  brain  be  now  laid  upon  its  under  surface,  when  of  course  the 
upper  surface  of  the  hemispheres  will  meet  the  eye.*  Let  the  membranes 
be  removed  from  these,  and  the  depth  of  the  fissures  separating  the  con- 
volutions, as  well  as  the  general  exact  correspondence  or  symmetry  of 
the  hemispheres  of  the  brain,  be  remarked.  The  great  fissure  separating 
them  longitudinally  is  deep  ;  at  the  bottom  of  it  a  broad  band  of  fibrous 
or  medullary  neurine  will  be  observed  ;  this  is  the  great  transverse  com- 
missure^ or  corpus  callosum  (figs.  77,  92,  95,  99,  100,  p,  the  same  let- 
ter in  all).  Before  entering  on  the  description  of  this  part,  let  me 
remind  the  student  of  the  simple  form  in  which  a  commissure  was  first 
presented  to  his  notice  in  the  nervous  system  of  the  star-fish,  where  it 
appeared  as  a  slender  cord  of  neurine  connecting  one  ganglion  with 
another. 

In  this  description  of  the  human  brain  I  shall  consider  under  the  head 
of  commissures  all  those  collections  of  medullary  neurine  which  are  so 
arranged  as  to  connect  either  corresponding  parts  which  are  placed  on 
each  side  of  the  mesial  line,  as,  for  instance,  the  right  and  left  hemi- 
spheres ;  or  different  organs  on  the  same  side,  as  the  various  convolutions 
of  each  hemisphere  ;  or  two  distinct  structures,  as  the  two  grand  divi- 
sions of  the  encephalon,  the  cerebrum  and  cerebellum  ;  thus  following 
out  to  its  fullest  extent  the  principles  which  have  been  laid  down  else- 
where, that  a  ganglion  is  a  collection  of  neurine  of  any  size  and  of  any 
form,  and  that  the  cerebro-spinal  axis,  of  which  the  brain  is  a  part,  is  no 
more  than  a  collection  of  ganglia  of  immense  size  connected  together 
by  commissures  of  corresponding  dimensions. 

Transverse  Commissure. — The  great  transverse  commissure^  or  corpus 

*  Supposing  the  student  only  to  have  one  brain  at  his  disposal,  he  must  replace  the  por- 
tion of  the  right  hemisphere  which  he  removed  when  directed  to  make  the  section  exposing 
the  centrum  ovale. 

f  Vicq  d'Azyr  was  the  first  anatomist  who  described  the  corpus  callosum  as  a  commissure, 
while,  on  the  other  hand,  Rolando  denies  that  it  is  entitled  to  the  name  of  a  commissure; 
for,  says  he, "  laying  together  the  observations  of  Wenzel  and  Tiedemann  upon  the  formation 
of  the  corpus  callosum,  and  my  own  observations  on  the  union  of  the  cerebral  vesicles, — the 
point  of  union  constituting  the  future  corpus  callosum,  this  is  obviously,  in  the  first  instance, 
no  more  than  a  contraction  of  the  superior  and  inferior  margins  of  the  vesicles ;  the  part 
cannot,  at  any  rate,  be  justly  described  as  a  commissure." — Op.  ctt.,  p.  72. 


COMMISSURES. 


207 


callosum,  is  a  body  consisting  of  fibres  of  medullary  neurine,  the  ex- 
tremities of  which  are  everywhere  in  contact  with  the  internal  or  central 
surface  of  the  cineritious  layer  which  forms  the  convolutions  of  the 
hemispheres — the  hemispherical  gnnglia.  These  fibres  consequently 
establish  a  communication  between  the  cineritious  neurine  of  the  whole 
convoluted  surface  of  both  sides  of  the  cerebrum. 

Fig.  99. 


This  figure  I  sketched  from  a  dissection  which  I  made  in  company  with  my  friend  Mr.  Grainger,  whpse 
testimony  ot  its  accuracy  I  am  glad  to  quote,  though  it  is  opposed  to  the  views  and  dissections  of  M. 
Foville.  It  is  intended  to  show  the  course  and  connection  of  the  fibres  of  the  great  transverse  commis- 
sure of  the  hemispheres  or  corpus  callosum.  The  dissection  has  only  been  carried  into  the  right  hemi- 
sphere. It  will  be  seen  that  these  fibres  ascend  to  the  convolutions  above  the  mesial  line,  p  v  p.  Fibres 
of  the  corpus  callosum  radiating  into  the  hemispherical  ganglion.  B.  Left  hemispherical  ganglion  undis- 
sected.  E.  Cerebellum.  Near  the  centre  of  the  drawing,  and  a  little  to  the  right  of  the  mesial  line,  is 
the  representation  of  a  broken  fasciculus  of  fibres — the  part  tori}  off  was  traced  most  carefully  into  the 
convoluted  surface  of  the  brain. 

Strictly  speaking,  the  fibres  of  the  great  transverse  commissure  do  not 
commence  on  one  side  more  than  another ;  but  with  the  hope  of  assist- 
ing the  mental  eye  in  following  their  course  from  hemisphere  to  hemi- 
sphere, these  fibres  shall  be  described  as  originating  on  the  right  side 
and  crossing  over  to  the  left.  The  fibres  from  the  front,  sides  and  supe- 
rior part  of  the  ^anterior  lobe,  then,  pass  backwards  and  inwards  to  the 
distance  of  an  inch  and  a  half  from  the  anterior  extremity  of  the  cere- 
brum, where  they  cross  the  fissure  which  divides  the  two  hemispheres. 
The  anterior  edge  of  the  commissure  consequently  forms  the  posterior 
boundary  of  the  anterior  part  of  the  fissure.  In  this  situation  the  fibres 
are  folded  one  upon  another;  so  that  on  a  transverse  section  of  the  com- 
missure the  anterior  edge  appears  thicker  than  the  centre,  though  it  is 
not  so  thick  as  the  posterior  edge  (see  fig.  100). 


208  HUMAN    BRAIN. 

The  fibres  from  the  convolutions  of  the  upper  part  and  sides  of  the 
middle  lobes  run  downwards  and  inwards,  being  joined  by  those  from 
the  convolutions  at  the  base  of  the  brain. 

Those  again,  from  the  upper,  under,  and  posterior  surface  of  the  pos- 
terior lobe,  run  forwards  and  inwards  to  cross  the  fissure  at  the  distance 
of  nearly  three  inches  from  the  posterior  extremity  of  the  cerebrum. 
The  fibres  from  such  extensive  surfaces  are  necessarily  numerous,  and 
give  a  considerable  thickness  to  the  posterior  edge  of  the  commissure.* 

All  these  fibres  may  be  easily  demonstrated  in  a  brain  that  has  been 
immersed  for  some  time  in  spirits,  and  they  may  also  be  shown,  though 
not  so  readily,  in  the  fresh  brain.  The  best  method  of  exposing  them 
is  gradually,  by  tearing,  to  remove  the  upper  part  of  the  hemispheres, 
the  handle  of  the  knife  being  pushed  into  the  horizontal  fissure  through 
which  the  commissure  creeps,  as  it  were,  under  the  convolutions  on  both 
sides  of  the  hemispheres.  The  dissection  here  had  better  be  confined 
to  the  right  side,  in  order  to  reserve  the  left  entire  for  other  observations, 
as  in  the  preparation  from  which  fig.  99  has  been  drawn. 

Let  me  again  repeat  that  I  consider  these  connecting  fibres  of  the  great 
commissure  as  performing  the  same  office,  and  that  they  ought  to  be 
considered  as  perfectly  analogous  structures  to  the  single  commissural 
cord  which  we  met  with  in  the  star-fish.  Their  vast  number,  which  is 
only  in  proportion  to  the  great  extent  of  surface  from  which  they  origi- 
nate or  which  they  connect,  ought  not  to  deceive  us  as  to  their  similarity, 
and  thus  withdraw  attention  from  the  illustration  of  their  real  character 
afforded  in  the  simple  type  of  the  nervous  system  as  it  exists  in  that 
animal. 

The  mode  of  tracing  the  fibres  of  the  transverse  commissure  recom- 
mended will  open  the  lateral  ventricle,  as  previously  described.  But 
let  me  again  remind  the  student,  that  this  space  must  not,  however,  be 
viewed  in  the  light  of  a  cell  or  cavity  situated  in  the  interior  of  the  brain, 
the  walls  of  which  are  formed  by  the  cerebral  mass  ;  but  that  he  must 
consider  it  as  resulting  merely  from  the  contact  of  the  different  surfaces 
of  the  brain.  The  external  surface  of  the  anterior  and  posterior  cerebral 
ganglia,  or  the  figurate  surface,  is  here  in  contact  with  the  internal  smooth 
surface  of  the  superficial  cerebral  convolutions  or  hemispherical  ganglia. 

The  next  commissure  to  which  our  attention  should  be  directed  is  a 
longitudinal  commissure.  I  have  designated  it  the  superior  longitudinal 
commissure  (see  fig.  100),  in  distinction  to  the  fornix,  which  I  have 
called  the  inferior  longitudinal  commissure;  the  former  being  situated 
above  the  great  transverse  commissure,  the  latter  below  it.  In  most 

*  M.  Foville,  op.  cit.,  gives  a  very  different  account  of  the  nature  of  the  corpus  callosum, 
and  the  origin  of  its  component  fibres.  He  considers  that  they  commence  from  the  corpus 
striatum  and  thalamus,  and  says  they  have  nothing  to  do  with  the  hemispheres,  but  in  reality 
form  a  commissure  between  the  two  crura  cerebri  of  a  vaulted  form.  Mayo,  in  his  Outlines 
of  Physiology,  has  very  clearly  proved  the  manner  in  which  that  mistake  has  occurred,  and 
shown  that  Foville,  in  producing  the  appearance  which  induced  him  to  adopt  the  opinion 
stated  above,  breaks  through  the  point  where  the  fibres  from  the  columns  intersect  the  com- 
missural fibres,  and  then  follows  the  columnal  fibres  in  their  course  to  the  striated  bodies. 
Rolando  advances  the  same  opinion  regarding  the  composition  of  this  commissure  as  Foville, 
quoting  the  opinions  of  Tiedemann  in  support  of  his  own.  Notwithstanding  such  weighty 
testimony,  I  am  convinced  from  repeated  dissections  that  they  have  been  deceived,  most 
probably  as  explained  by  Mayo  in  his  Physiology. 


COMMISSURES. 


209 


systematic  works  we  do  not  find  any  mention  whatever  made  of  these 
fibres.  Mayo,  with  his  usual  accuracy  of  observation,  has  delineated 
them  in  his  Plates  of  the  Brain,  showing  on  their  external  aspect,  what 
I  have  exhibited  on  their  internal,  in  fig.  100,  where  they  are  repre- 
sented as  they  run  above  the  transverse  commissure  on  the  edge  of 
the  longitudinal  fissure.  Mayo  did  not  give  them  any  distinctive  or 
generic  appellation.  These  fibres  may  be  easily  seen  by  removing  the 
surface  of  the  convolutions  where  they  form  the  lower  part  of  the 
outer  wall  of  the  above  fissure. 


Fig.  100. 


This  figure  represents  longitudinal  fibres  placed  above  the  great  transverse  commissure  corresponding 
with  those  which  we  have  just  observed  below  it — tfie  superior  longitudinal  commissure.  The  relations 
being  more  simple  than  those  of  the  inferior  commissure,  are  simply  designated  by  the  letters  s  L.  s  L. 
They  are  traced,  ascending  forwards,  from  the  locus  quadratus,  which  is  anterior  to  the  fissura  Sylvii, 
and  then,  curving  backwards  and  winding  round  the  front  of  the  great  transverse  commissure  (P),  receiv- 
ing fibres  from  all  the  convolutions  at  the  upper  and  sides  of  the  hemispheres,  winding  round  the  posterior 
extremity  of  the  same  commissure,  and  terminating  after  crossing  the  fissura Sylvii,  where  it  commenced 
in  the  locus  quadratus  at  the  base  of  the  brain.  H.  Spinal  cord.  J.  Pituitary  gland,  just  above  which  is 
the  divided  optic  nerve.  N.  Letter  placed  on  the  crus  cerebri,  and  behind  that  root  of  the  fornix  which 
springs  from  the  interior  of  the  thalamus.  p.  Great  transverse  commissure,  s.  Olivary  ganglion,  a, 
Olfactory  ganglion,  c  D.  Optic  ganglia,  c  a.  Corpus  manimillare,  formed  by  the  twist  of  the  tbrnix. 
cm.  Commissura  mollis  in  the  third  ventricle,  k.  Optic  thalamus.  o.  Peduncle  of  the  pineal  gland:  if 
this  line  is  traced  backwards  it  will  be  found  connected  with  a  dark  rounded  body,  the  pineal  gland, 
which  is  lying  on  the  anterior  optic  tubercle — nates;  if  this  line  is  traced  forwards  it  will  be  seen  joining 
the  anterior  pillar  of  the  fornix,  which  has  been  turned  down  to  show  this  connection.  The  divided  end 
of  the  fornix  is  turned  towards  us.  p  c.  Posterior  commissure,  s.  Ta3in'a  semicircularis  joining  the  for- 
nix at  the  same  point.  This  letter  is  placed  in  the  anterior  cornu  of  the  lateral  ventricle  on  the  corpus 
striatum.  This  junction  is  very  distinct  in  both  the  recent  and  hardened  brain,  though  the  connecting 
fibres  are  too  delicate  to  be  done  justice  to  in  a  woodcut.  4.  Fourth  ventricle,  v.  Iter  a  tertio  ad  quartum 
ventriculum.  u.  Posterior  commissure. 

The  convolution  which  is  opened  to  show  this  commissure  is  the 
"  convolution  de  Vourlet"  and  from  the  centre  of  it  these  fibres  may  be 
traced  either  backwards  or  forwards.  In  tracing  them  forwards,  we  find 
them  turning  over  the  anterior  edge  of  the  transverse  commissure,  and 
running  down  to  those  convolutions  at  the  base,  which,  forming  the  under 


210  HUMAN   BRAIN. 

and  back  part  of  the  anterior  lobe,  are  placed  close  to  the  locus  quadratus 
in  front  of  thefasura  Sylvii :  these  fibres  do  not,  however,  form  merely 
a  narrow  band,  but  an  extended  plane,  the  exact  width  of  which  cannot 
be  defined,  as  its  constituent  fibres  are  in  contact  with  the  internal  surface 
of  all  that  part  of  the  hemispherical  ganglion  which  is  to  the  outer  side 
of  the  longitudinal  fissure.  The  posterior  fibres  run  backwards  in  the 
same  manner  in  which  the  anterior  run  forwards,  terminating  in  like 
manner  in  the  convolutions  at  the  under  part  of  the  hemispheres,  running 
across  the  fissura  Sylvii  to  the  locus  quadratus,  where  we  traced  the  an- 
terior. No  one,  I  think,  can  trace  this  longitudinal  commissure  without 
acknowledging  the  justice  of  Spurzheim's  observation,  when  after  de- 
scribing and  reasoning  on  the  composition  of  the  fornix,  and  the  appara- 
tuses of  communication  in  the  brains  of  the  lower  animals,  he  says, 
"  Thus,  the  especial  pains  which  nature  has  taken  to  establish  communi- 
cations between  cerebral  parts  cannot  be  overlooked,  and  it  is  this 
arrangement  which  enables  us  to  understand  the  mutual  influence. of  their 
functions  respectively."  Nevertheless,  it  is  rather  extraordinary  that  he 
should  make  no  mention  of  the  fibres  above  described  as  constituting 
the  superior  longitudinal  commissure. 

The  lateral  ventricle  must  next  be  opened,  as  directed  at  page  165. 
The  student  will  again  observe  a  structure,  already  briefly  noticed,  namely, 
the  fornix.  In  pursuing  the  dissection  of  this  commissure,  where  we 
have  not  more  than  one  brain  at  our  command,  a  difficulty  arises  from  its 
lying  over  and  concealing  from  view  the  transverse  commissures  which 
remain  to  be  studied.  This  obliges  us  to  divide  it  and  turn  it  back,  in 
order  that  the  others  may  be  seen ;  as  this  proceeding  interferes  with 
that  perfect  and  minute  dissection  of  the  inferior  longitudinal  commis- 
sure, which  can  only  be  accomplished  on  a  brain  almost  entirely  devoted 
to  it,  a  drawing  of  the  fornix  has  been  introduced  in  fig.  101,  with  the 
view  of  assisting  the  student  to  a  knowledge  of  its  complicated  relations. 
The  longitudinal  commissure  must  now  be  divided  in  the  middle,  just 
opposite  the  divided  end  of  the  transverse  commissure,  but  not  removed, 
as  we  must  return  to  the  study  of  it ;  this  being  done,  the  posterior  por- 
tion must  be  turned  back,  when  the  optic  thalami  on  both  sides  may  be 
distinctly  brought  into  view  with  a  fissure  of  some  depth  between  them 
(third  ventricle).  See  fig.  78. 

Commissura  Mollis. — Crossing  the  centre  of  this  median  fissure,  the 
so  called  third  ventricle,  is  the  commissura  mollis,  consisting  almost  en- 
tirely of  cineritious  neurine.  It  connects  the  two  thalami'  together. 
This  corresponds  with  the  gray  matter,  which,  crossing  the  mesial  line  in 
the  spinal  cord,  connects  the  two  sides  of  the  spinal  cord  together  (see 
fig.  100,  c  m). 

Pineal  Commissure. — Running  from  before  backwards  along  the  inner 
edge  of  the  thalami  a  white  line  may  be  seen  formed  by  a  collection  of 
medullary  fibres,  which  are  connected  to  the  pineal  gland  in  the  mesial 
line  ;  these,  through  the  intervention  of  that  body,  form  the  pineal  com- 
missure before  mentioned  (see  figs.  78,  100). 

Posterior  Commissure. — The  pineal  commissure  may  now  be  divided  ; 
beneath  it,  and  just  anterior  to  the  optic  tubercles,  a  narrow  band  of 


COMMISSURES.  211 

medullary  neurine  will  be  perceived  ;  this  is  the  posterior  commissure; 
its  fibres  may  be  traced  in  the  thalami  on  each  side  (fig.  100,  pc). 

interior  Commissure. — The  whole  extent  of  this  commissure  cannot 
be  perfectly  seen  in  this  stage  of  the  dissection  ;  but  if  the  student  direct 
his  attention  to  the  anterior  boundary  of  the  fissure  called  the  third  ven- 
tricle, he  will  see  two  rounded  cords,  which  are  called  the  anterior  pillars 
of  the  fornix,  the  nature  of  which  will  be  explained  hereafter.  Between 
these  two  cords  a  transverse  commissure  may  be  observed  :  this  is  the 
anterior  commissure  ;  and  the  only  portion  of  it  brought  into  view  is  that 
which  runs  across  the  small  fissure  left  between  the  anterior  pillars  of  the 
longitudinal  commissure;  its  dissection  will  be  most  conveniently  con- 
ducted at  the  base  of  the  brain,  where  it  will  be  found  (having  been 
already  exposed  in  the  dissection  of  the  passage  of  the  motory  tract 
through  the  anterior  cerebral  ganglion  of  the  cord,  see  fig.  91,)  to  be 
about  three  lines  in  width,  and  commencing  in  the  middle  of  the  hemi- 
spheres to  pass  through  the  substance  of  the  corpus  striatum  or  anterior 
cerebral  ganglion,  apparently  receiving  additional  fibres  from  the  cineri- 
tious  neurine  of  the  most  external  portion  of  this  ganglion ;  near  to  the 
internal  edge  of  the  ganglion,  however,  the  anterior  commissure  becomes 
quite  distinct  from  it,  and  crosses  over  to  the  corresponding  ganglion  of 
the  opposite  side,  in  front  of  the  anterior  pillars  of  the  longitudinal  com- 
missure. From  the  outer  part  of  this  commissure  some  fibres  may  be 
traced  to  the  olfactoy  nerves;  these  were  first  discovered  by  Spurzheim, 
in  1821,  and  are  mentioned  in  his  thesis  entitled  "Encephalotomie." 
The  portion  running  to  the  olfactory  nerve  forms  an  arc  the  convexity  of 
which  is  turned  backwards,  the  concavity  forwards.* 

Pons  Varolii — Transverse  Commissure  of  the  Cerebellum. — This  is  the 
last  of  the  transverse  commissures  to  be  dissected  ;  the  appearance 
which  it  presents  will  be  already  familiar  to  the  student,  as  he  has  traced 
the  fibres  of  the  spinal  cord  through  its  centre.  The  fibres  of  which  it 
consists  running  from  one  lateral  lobe  of  the  cerebellum  to  the  other, 
can  be  seen  on  the  surface  without  dissection,  and  these  are  sufficient  to 
establish  its  commissural  character.  But  if  we  make  a  section  through 
it  we  find,  in  addition  to  medullary  fibres,  there  is  a  large  quantity 
of  the  vesicular  or  cineritious  neurine.  The  presence  of  this  neurine 
gives  to  it  a  ganglionic  character.  This  gray  matter  is  not  found  in  the 
anterior  portion  of  the  commissure,  but  in  the  posterior  division,  where 
the  fibres  of  the  cord  traverse  it.  Burdach  saw  immediately  the  import- 
ance of  this  fact,  and  concludes  that  its  presence  has  some  relation  to 
the  formation  of  the  longitudinal  fibres.  The  connection  of  the  commis- 
sural fibres  to  the  cerebellum  will  be  given  in  the  description  of  this 
organ. 

Inferior  Longitudinal  Commissure,  or  Fornix.] — The  commissure  to 

*  Chausssier  and  Tiedemann  both  regard  the  anterior  commissure  as  a  continuation  of 
the  cerebral  crura;  but  with  all  due  respect  to  such  high  authorities,  I  cannot  agree  with 
them ;  for  in  pursuing  the  dissection  which  has  been  already  described,  tracing  the  course  of 
the  anterior  fibres  through  the  corpus  striatum,  and  giving  the  utmost  attention  to  the  rela- 
tions of  the  anterior  commissure,  it  will  be  found  that  there  is  no  continuity  of  fibre  between 
the  peduncles  of  the  brain  and  the  anterior  commissure. 

t  Cruveilhier,  when  speaking  of  the  fornix,  p.  720,  says,  u  Shall  it  be  considered  as  *n 
anterior  posterior  commissure  ?"  As  a  circumstance  favorable  to  this  view,  I  recall  to  mind 


212 


HUMAN    BRAIN. 


which  we  must  next  direct  our  attention  is  the  inferior  longitudinal  commis- 
sure or fornix  (see  fig.  101),  which  having  been  divided  in  its  centre  in  the 
course  of  the  preceding  dissection,  must  be  replaced  in  its  normal  position. 

Fig.  101. 


This  figure  has  been  introduced  with  the  view  of  assisting  the  student  in  his  study  of  the  relations  of 
Ihe  inferior  longitudinal  commissure  or  fornix,  which  may  be  described  as  commencing  in  the  centre  of 
the  thalamus  nervi  optici  (L),  proceeding  from  thence  to  the  base  of  the  brain,  where  it  suddenly  bends 
upwards  and  forwards,  forming  by  this  turn  the  knuckle  (B).  which  is  called  corpus  albicans  or  mammillare. 
This  body  receives  a  few  fibres  (A)  from  the  locus  niger  (6)  in  the  crus  cerebri  (5),  running  forward  from 
thence  towards  the  anterior  commissure,  receiving  fibres  from  the  convolutions  at  the  base  of  the  brain, 
crossing  and  as  it  were  kneeling  upon  the  anterior  commissure  (s),  and,  ascending  towards  the  great 
transverse  commissure,  forms  the  anterior  pillar  of  the  fornix  (c),  receiving  fibres  in  its  course  from  the 
under  and  front  part  of  the  anterior  lobes,  and  thus  forming  the  (septum  lucidum  (D)  :  running  back  from 
thence,  passing  in  its  course  backwards  over  the  thalamus  nervi  optici  (L).  it  spreads  laterally,  constitut- 
ing that  portion  which  is  called  the  body  of  the  fornix  (E)  ;  descending  again  at  the  back  part  of  the  brain 
it  forms  the  descending  or  posterior  pillar  of  the  fornix  teenia  hippocampi  (F),  some  of  its  fibres  running 
back  to  be  connected  with  the  posterior  lobes  (i);  others  crossing  the  projection  called  hippocampus  ma- 
jor (G),  to  be  connected  with  the  middle  lobe,  and  others  again  passing  over  the  pes  hippocampi  (H)  to  be 
connected  with  the  anterior  portion  of  the  middle  lobe.  Thus  does  this  commissure  connect  different 
portions  of  the  convoluted  surface  of  the  brain  together,  which  are  inferior  to  the  great  transverse  com- 
missure, and  on  the  same  side  of  the  mesial  line.  A.  Fibres  of  the  inferior  longitudinal  commissure,  or 
fornix,  from  the  locus  niger.  B.  Corpus  mammillare.  c.  Anterior  pillars  of  inferior  longitudinal  commis- 
sure, or  fornix.  D.  Septum  lucidum.  E.  Body  of  the  fornix,  or  centre  of  the  commissure.  F.  Tsenia 
hippocampi,  or  descending  fibres  of  the  inferior  longitudinal  commissure.  G.  Fibres  covering  the  hip- 
pocampus major.  H.  Fibres  covering  the  pes  hippocampi,  i.  Fibres  covering  the  hippocampus  minor. 
K.  Great  transverse  commissure  divided  in  the  mesial  line.  s.  Posterior  cerebral  ganglion,  or  thalamus. 
L  Anterior  commissure.  5.  Section  of  the  crus  cerebri.  6.  Locus  niger.  7.  Anterior  cerebral  gan- 
glion, or  corpus  striatum,  partially  scraped  away. 

This  part  has  not  been  generally  described  in  the  light  of  a  commissure. 
By  Vieussens  it  was  considered  simply  as  the  under  surface  of  the  cor- 
pus callosum  ;  but  the  direction  of  its  fibres  being  so  entirely  different, 
that  is,  being  longitudinal  instead  of  transverse,  it  is  impossible  to  agree 
with  that  celebrated  author  in  this  view  of  the  relations  of  the  fornix. 
The  name  of  Fornix  is  derived  simply  from  its  vaulted  figure,  for  it  forms 
in  the  centre  of  the  cerebral  mass  a  surface  which  is  convex  superiorly 
and  concave  inferioriy,  bearing,  therefore,  some  resemblance  to  an  arched 
or  vaulted  roof.  By  the  German  anatomists  it  is  called  the  twain  band. 
If  the  student  will  here  refer  to  fig.  101,  he  will  find  the  following  de- 
scription considerably  elucidated. 

The  general  form  of  the  fornix  may  be  described  as  that  of  a  vaulted 
roof  supported  upon  four  pillars,  which,  unlike  pillars  in  general,  are 
bent  nearly  double,  the  anterior  pair  presenting  their  concavity  forwards, 

that  I  have  seen  the  right  half  of  this  vault  atrophied  in  a  case  of  destruction  of  those  cere- 
bral convolutions  which  lie  on  the  tentorium  cord. 


COMMISSURES.  213 

the  posterior  pair  theirs  backwards.  Its  real  character,  and  the  direction 
of  the  fibres  composing  it,  will  be  ascertained  by  making  a  section  of 
the  brain,  so  as  to  obtain  a  side  view  of  it ;  and  in  order  to  effect  this, 
the  crus  cerebri  on  the  right  side  should  be  divided  by  an  incision  just 
between  the  optic  tubercles  and  the  posterior  cerebral  ganglion  ;  and  the 
scalpel  being  kept  quite  close  to  the  inner  side  of  that  ganglion,  the  in- 
cision may  be  carried  forward,  running  also  on  the  inner  side  of  the 
motory  ganglion,  and  then  cutting  through  the  anterior  lobe  into  the 
anterior  fissure,  as  has  been  done  in  the  dissection  from  which  fig.  101 
is  taken.  This  commissure,  like  every  other  commissure,  cannot,  strictly 
speaking,  be  described  as  commencing  in  one  part  more  than  another; 
in  describing  it,  therefore,  as  commencing  in  the  crus  cerebri,  it  must  be 
remembered  that  it  would  be  equally  correct  to  describe  it  as  terminating 
there  ;  but  being  obliged  to  suppose  it  to  commence  at  some  point,  we 
shall  speak  of  it  as  arising  from  the  cineritious  neurine,  or  locus  niger, 
in  the  centre  of  the  crus  cerebri. 

From  the  centre  of  the  crus  cerebri  the  fibres  of  the  longitudinal 
commissure  may  be  traced  to  the  corpora  mammillaria,  at  which  point 
they  are  joined  by  a  band  from  the  interior  of  the  thalamus,  which  can 
be  most  easily  dissected  when  the  brain  rests  on  its  upper  surface  and 
the  base  is  exposed  (fig.  101,  B;  fig.  IjJO,  c  a),  when  it  will  be  found 
that  this  little  body  is  produced  by  a  turn  of  the  band  coming  from  the 
interior  of  the  thalamus;  for  this  band,  after  emerging  from  the  thala- 
mus, first  runs  directly  inwards,  then  turns  suddenly  forwards  and  forms 
a  sort  of  knot,  such  as  we  can  imitate  exactly  by  means  of  our  handker- 
chief or  soft  cloth.  This  arrangement  is  very  well  delineated  in  Langen- 
beck's  Plates  of  the  Brain  ;  it  has  been  described  and  designed  by  Vicq 
d'Azyr.  Reil  was  also  aware  of  its  existence.  Cruveilhier  states  that 
he  has  traced  it  to  a  connection  with  the  taenia  semicircularis.  Prof. 
Erie  considers  that  he  has  traced  fibres  from  the  optic  nerve  through  the 
thalamus  into  this  band,  and  continuous  with  the  fornix  in  the  course 
now  described. 

From  the  corpora  mammillaria  the  fibres  are  collected,  so  as  to  form 
two  rounded  cords ;  the  course  of  these  is  first  forwards,  then  upwards, 
and  afterwards  backwards,  thus  forming  a  semicircle,  the  concavity  of 
which  facing  backwards  used  to  be  called  the  anterior  pillars  of  the  for- 
nix, and  is  free  and  unattached,  whilst  the  anterior  or  convex  edge  re- 
ceives fibres  from  the  anterior  lobes  and  beneath  the  great  transverse 
commissure,*  by  which  means  a  thin  delicate  septum  is  formed,  called 
the  septum  lucidum.^ 

These  pillars  also  receive  two  sets  of  fibres  anteriorly ;  first,  from  a 
white  band  which  has  already  been  under  the  notice  of  the  student — 
the  tania  semicircularis — running  in  a  groove  between  the  thalamus  and 
corpus  striatum ;  the  tcenia  semicircularis  commences  (see  fig.  100,  s) 

*  I  believe  that  I  was  the  first  to  describe  the  septum  lucidum  as  consisting  of  longitudinal 
fibres,  and  thus  forming  a  portion  of  the  longitudinal  commissure. 

•f  Rolando  describes  the  septum  lucidum  as  a  folding  in  of  the  fibres  of  the  hemispheres 
from  the  corpus  callosum.  The  direction  of  its  component  fibres  convinces  me,  however, 
that  such  cannot  be  a  true  view  of  its  construction,  and  the  fornix  as  a  whole  he  views  as 
merely  a  portion  of  the  corpus  callosum. 


214  HUMAN   BRAIN. 

from  the  middle  lobe  in  the  descending  cornu  of  the  lateral  ventricle, 
and  is  continued  through  the  body  of  the  lateral  ventricle  into  the  an- 
terior columns  of  the  fornix:  secondly,  a  set  which  are  described  further 
on  as  the  peduncles  of  the  pineal  gland  or  the  pineal  commissure, 
beneath  the  last  (fig.  100,  o).  The  longitudinal  commissure  in  its  pass- 
age backwards  under  the  great  commissure  (corpus  callosum),  to  which 
it  is  attached,  spreads  laterally,  and  at  first  is  nearly  of  the  width  of 
half  an  inch ;  while  tracing  its  fibres  in  this  portion  of  its  course,  two 
projections  are  observed,  which  have  received  the  names  of  hippocam- 
pus major,  and  hippocampus  minor ;  they  are  situated  in  the  descending 
and  posterior  cornua  of  the  lateral  ventricles. 

"  The  hippocampus,"  says  Wenzel,  (p.  134,  op.  cit.,)  "  from  the  time  of 
Arantius,  who  first  described  them  (Observations  Anatomicae,  Venetiis 
1587,  4  Observat.  3,  page  45),  to  that  of  Haller,  was  considered  as  a 
continuation  of  the  fornix,  or,  in  the  words  of  Haller,  upro  fornicis 
ipsius  cruribus."  Haller  referred  them  to  the  corpus  callosum,  consider- 
ing them  as  continuous  with  its  structure,  saying  (Commentaria  ad  pra3- 
lectiones  academicas,  H.  Boerhaave,  tome  ii.,  Taurino  1743,-4,  p.  509), 
"  Nobis  imprimis  ta3nis  continua?  videntur  fornici  tubera  fornix  ad  tan- 
turn  horum  corporum  molem,  neque  posteriores  pedes  hippocampi  facere 
possit." 

Gunz  (Prolusio,  Observationes  anatomicas  de  cerebri  continens  altera. 
Leipsiae  1750,  4)  points  out  very  decidedly  that  the  corpus  fimbriatum, 
as  it  is  usually  called,  is  the  true  pillar  of  the  fornix. 

In  this  division  of  our  subject  it  will,  I  think,  be  advisable  to  inquire 
into  the  real  character  of  these  hippocampi,  and  the  relation  they  bear 
to  other  parts  of  the  brain. 

If  the  hippocampus  major  be  examined  carefully  in  a  brain  that  has 
been  thoroughly  hardened  in  spirits  of  wine,  it  will  be  found  to  consist 
of  cineritious  neurine  covered  by  a  thin  layer  of  medullary  fibres.  The 
cineritious  neurine  is  on  the  same  plane,  and  continuous  with  the  con- 
volutions at  the  base  of  the  brain,  and  is  in  reality  a  true  convolution; 
the  medullary  fibres  come  from  the  under  part  of  the  cerebrum  in  various 
directions,  and  being  collected  at  the  inner  edge  of  this  body,  form  what 
have  usually  been  called  the  posterior  pillars  of  the  fornix,  or  the  tsenia 
hippocampi,  but  which  we  must  regard  as  the  posterior  descending  ex- 
tremity of  the  inferior  longitudinal  commissure. 

The  cineritious  neurine  over  which  these  fibres  of  the  longitudinal 
commissure  run  from  before  backwards,  and  from  below  upwards,  is,  in 
fact,  nothing  more  than  a  continuation  of  that  neurine  which  constitutes 
a  portion  of  the  convoluted  surface  of  the  brain,  neither  more  nor  less, 
therefore,  than  a  part  of  the  hemispherical  ganglion,  but  in  this  situation 
covered  by  the  inferior  fibres  of  the  longitudinal  commissure.  Its  large 
size  in  some  of  the  lower  animals,  especially  those  in  whom  the  olfactory 
ganglia  are  much  developed,  has  gained  for  it  by  some  anatomists  the 
title  of  hippocampal  lobe;  and  though  clearly  a  continuous  portion  of 
the  cortical  substance  of  the  brain,  in  all  probability  it  has  its  peculiar 
and  individual  office  to  perform  in  relation  to  the  sense  of  smell. 

Wenzel  was  aware  of  its  real  character,  justly  observing,  (p.  141,) 
"Hippocampus  ergo,  manifest!  nihil  aliud  est,  nisi  continuatio  superficii 


COMMISSURES.  215 

cerebri  intro  flexa,  sive  in  unam  lateralium  ventriculorum  partem ;  sive 
hippocampus  nil  est  nisi  unius  gyrorum  in  superficii  cerebri  sitorum  in 
interius  cerebri  prolongatio."  « 

The  hippocampus  minor  is  in  some  respects  analogous  to  the  hippo- 
campus major;  for  it  is  formed  by  the  projection  of  one  of  the  fissures 
dividing  the  convolutions  at  the  inner  side  of  the  posterior  lobe,  where 
it  is  covered  by  the  posterior  fibres  of  the  longitudinal  commissure.  It 
differs  from  the  hippocampus  major  in  this  respect,  that  the  projection  is 
caused  by  the  central  surface  of  the  convolutions,  and  not  by  the  peri- 
pheral surface,  as  is  the  case  in  the  hippocampus  major. 

This  account  of  the  fibres  which  enter  into  the  composition  of  the 
inferior  longitudinal  commissure  will  prove  to  the  student  that  this  struc- 
ture connects  the  cineritious  neurine  or  locus  niger  of  the  crura  cerebri 
and  the  thalami  nervorum  opticorum  with  the  convolutions  of  the  hemi- 
spheres, as  well  as  most  of  the  convolutions  of  the  same  hemisphere, 
together,  and  is  in  this  respect  distinguished  from  the  great  transverse 
commissure,  whose  office  is  to  connect  the  two  opposite  hemispheres 
together.  It  must  be  regarded,  therefore,  as  an  apparatus  of  union  be- 
tween different  points  of  the  same  hemispherical  ganglia.  The  presence 
of  these  two  longitudinal  commissures  connecting  together  different  parts 
of  this  extensive  layer  of  vesicular  neurine  may  be  regarded  as  offering 
presumptive  evidence  in  favor  of  the  opinion,  that  this  ganglion,  though 
anatomically  but  one  centre,  physiologically  consists  of  many,  which  is 
the  fundamental  principle  of  phrenology. 

There  is  another  portion  of  cineritious  neurine  which  I  am  compelled 
to  mention  in  consequence  of  its  being  uniformly  described  in  all  descrip- 
tions of  the  brain  under  the  silly  name  of  corpus  denticulatum ;  I  say 
silly  name,  because  it  would  have  been  equally  wise  to  have  given  a 
particular  appellation  to  every  square  inch  of  the  convoluted  surface  as 
to  this  portion,  which  is  partly  covered  by  the  posterior  pillar  of  the 
longitudinal  commissure.  The  corpus  denticulatum  is  neither  more  nor 
less  than  a  portion  of  the  hemispherical  ganglion,  which,  being  brought 
into  view  according  to  the  old  method  of  dissecting  the  brain  by  cutting 
through  the  posterior  pillar  of  the  fornix,  appeared  to  be  a  distinct  part 
deserving  an  appropriate  title. 

Inter- cerebral  Commissure,  or  Cerebral- cerebello  Commissure. — The  re- 
maining commissure  which  demands  our  attention  consists  of  medullary 
fibres  connecting  the  two  great  cerebral  masses,  the  cerebrum  and  the 
cerebellum,  together,  as  well  also  as  the  optic  tubercles  and  the  cere- 
bellum ;  these  fibres  have  been  briefly  noticed  before  under  the  name  of 
the  inter-cerebral  commissure,  consisting  of  fibres  thick  and  strong  on 
each  side,  but  extremely  thin  and  delicate  in  the  centre ;  the  fibres  are 
arranged  longitudinally  in  both  situations  (fig.  77,  fig.  102,  i  &  c). 

The  constituent  fibres  of  this  commissure  are  not  so  simply  arranged 
as  we  might  in  the  first  instance  be  inclined  to  suspect.  To  me  they 
appear  to  be  divisible  into  three  sets ;  and  as  they  are  all  collected  to- 
gether at  the  point  where  they  enter  the  cerebellum,  we  shall  describe 
them  from  that  point  forwards. 

1st.  The  most  superior,  those  in  fact  which  form  the  surface  of  the 


216 


HUMAN    BRAIN. 


processuse  cerebello  ad  testes,  and  the  valve  of  Vieussens,  may  be  traced 
distinctly  to  the  optic  tubercles. 

2dly.  The  external;  these  form  the  external  surface  of  the  processus 
e  cerebello  ad  testes,  and  may  be  traced  to  the  side  of  the  optic  tuber- 
cles, and  thence  to  the  optic  thalami,  and  as  far  as  I  can  discover,  though 
I  cannot  speak  decidedly,  through  that  ganglion  to  the  hemispheres. 

3dly.  The  third  and  last  set  are  the  deep  or  descending  fibres:  these 
may  be  seen  by  first  dividing  the  cerebellum  into  two  halves,  then  divi- 
ding close  to  the  cerebellum  that  portion  of  the  pons  Varolii  called  the 
crus  cerebelli,  and  the  corpus  restiforme.  If  the  cerebellum  be  now 
raised,  tearing  up  the  inter-cerebral  commissure,  it  will  be  found  that 
some  of  its  fibres  descend,  and  in  so  doing  interlace  with  the  ascending 
fibres  of  the  sensory  tract :  these  descending  fibres  may  be  traced  through 
the  locus  niger  of  the  crus  cerebri  till  they  become  continuous  with  the 
motor  tract,  and  also  with  the  portion  of  the  longitudinal  commissure 
or  fornix  which  takes  its  origin  at  that  point.  See  fig.  107,  i  &  c,  re- 
presenting the  relation  of  the  fifth  pair  of  nerves  to  this  commissure. 

A  perpendicular  incision  having  been  made  through  the  centre  of  the 
cerebellum,  the  course  of  this  commissure  into  its  interior  may  be  next 
demonstrated,  and  at  the  same  time  that  beautiful  appearance,  which 
from  its  resemblance  to  the  branches  of  a  tree  is  called  the  arbor  vita, 
observed  distinctly  exposed. 

Fig.  102. 


c.  Anterior  optic  tubercle.  D.  Posterior  ditto.  E.  Cerebellum  divided,  showing  the  arbor  vitro.  F.  The 
descending  fibres  of  the  inter-cerebral  commissure,  i  &  c.  Another  portion  of  the  same  commissure, 
ir.  Crus  cerebri.  x.  Commissure  of  the  cerebellum  divided,  z.  Portion  of  the  olivary  tract  and  resti- 
form  body,  divided  from  the  cerebellum,  and  raised  so  us  to  show  the  motor  origin  of  the  fifth  pair  of 
nerves  (e).  c.  Third  pair  of  nerves,  d.  Fourth  pair  of  nerves,  e.  Motor  origin  of  the  fifth. 

On  reviewing  what  has  been  said  on  the  commissures  it  will  be  found 
that  they  may  be  arranged  under  two  heads;  the  transverse  and  longi- 
tudinal. " 

The  transverse  commissures,  six  in  number. 

1.  The  great  transverse  commissure  of  the  hemispheres,  or  the  cor- 

pus callosum. 

2.  The  pineal  commissure. 


CEREBELLUM.  217 

3.  The  posterior  commissure,  or  commissure  of  the  posterior  cere- 

bral ganglia,  or  thalami  nervorum  opticorum. 

4.  The  soft  commissure,  or  commissure  also  of  the  posterior  cere- 

bral ganglia. 

5.  The  anterior  commissure,  or  commissure  of  the  anterior  cerebral 

ganglia  or  corpora  slriata. 

6.  The  commissure  of  the  cerebellum,  or  pons  Varolii. 
The  longitudinal  commissures,  four  in  number. 

1.  The  superior  longitudinal  commissure. 

2.  The  inferior  longitudinal  commissure,  or  fornix. 

3.  The  inter-cerebral  commissure,  or  processus  e  cerebello  ad  testes, 

with  the  valve  of  Vieussens. 

4.  The  olivary  commissure. 

The  Cerebellum. — This  portion  of  the  encephalon  is  situated  in  the 
posterior  division  of  the  skull  beneath  the  cerebrum.  In  the  human 
subject  it  is  more  completely  overlapped  by  the  cerebrum  than  in  any 
other  animal. 

The  portion  of  the  skull  in  which  it  is  contained  is  bounded  superiorly 
by  the  tentorium,  by  which  it  is  separated  from  the  posterior  lobes  of  the 
cerebrum,  posteriorly  and  inferiorly  by  the  occipital  bones,  laterally  and 
anteriorly  by  the  temporal  and  parietal  bones. 

The  superior  surface  of  the  cerebellum  is  almost  flat,  but  is  not  placed 
quite  horizontally,  rising  anteriorly  where  it  comes  in  contact  with  the 
optic  tubercles  (fig.  105). 

The  relative  position  of  the  cerebellum  to  the  cerebrum  and  the  occi- 
pital bone,  and  thus  to  its  position  in  the  neck,  is  very  clearly  exhibited 
in  fig.  71,  E,  and  should  be  reflected  upon  by  the  student  before  he  re- 
moves the  cerebellum  from  the  cerebrum,  in  order  to  study  its  external 
configuration  and  dissect  the  course  of  its  fibres.  For  he  cannot  clearly 
observe  each  surface  of  the  cerebellum  unless  it  is  removed  with  the 
medulla  oblongata  from  the  cerebrum  by  cutting  through  the  crura 
cerebri.' 

The  pia  mater  and  arachnoid  must  next  be  carefully  and  entirely  dis- 
sected from  every  portion  of  it,  as  well  as  from  the  pons  Varolii  and 
medulla  oblongata.*  This  having  been  done,  and  its  superior  face  ob- 

*  The  following  directions  are  given  by  Reil,  for  the  preparation  of  the  cerebellum.  "  The 
cerebellum  of  a  male  should  be  selected,  and  of  one  who  may  have  died  in  early  manhood 
of  some  chronic  disease;  it  should  be  in  as  fresh  a  state  as  possible  ;  the  brains  of  those  who 
have  died  of  typhus  lose  their  consistence  too  soon  for  this  purpose,  and  where  inflamma- 
tion of  the  brain  has  existed,  the  membranes  are  not  easily  separable.  The  cerebellum 
may  be  detached  by  dividing  the  crura  cerebri  above,  and  the  medulla  oblongata  below ;  it 
should  then  be  placed  in  a  basin  under  water,  and  the  membranes  removed  with  the  forceps ; 
the  membranes  are  prevented  from  drying,  and  the  blood  exudes  more  freely,  when  the  part 
is  thus  immersed  in  water.  The  denuded  cerebrum  is  now  to  be  placed  in  a  vessel,  and 
to  be  twice  washed  by  the  effusion  of  brandy,  which  may  be  suffered  to  remain  on  it  some 
minutes ;  afterwards  alcohol  is  to  be  substituted,  in  which  it  should  stand  twelve  hours ; 
when,  in  this  way,  the  surface  appears  somewhat  hardened,  the  membrane  is  to  be  removed 
from  the  deeper  furrows,  in  order  that  the  spirit  may  everywhere  penetrate  the  mass;  spirit 
is  then  again  to  be  poured  over  the  preparation,  which  may  stand  a  day  or  two:  finally  the 
alcohol  is  to  be  renewed,  and  the  vessel  closed  and  set  by  for  two  or  three  months,  till  the 
part  has  acquired  a  grayish  color,  and  is  thoroughly  hardened.  It  is  right,  during  this  time, 
to  turn  the  preparation  occasionally,  and  to  contrive  that  every  surface  is  freely  bathed  in 
the  spirit." 


218  HUMAN    BRAIN. 

served,  it  will  be  found  to  consist  of  innumerable  laminae,  separated  by 
furrows  which  take  a  curved  direction,  the  concavity  forwards,  and  con- 
vexity backwards.  These  fissures  between  them  vary  in  depth  from  a 
line  to  half  an  inch,  increasing  from  before  backwards. 


Fig.  103. 


Superior  surface  of  the  cerebellum,  a  a.  Lateral  lobes,  b.  Lobulus  quadratus,  or  square  lobe.  c. 
Superior  semilunar  lobe.  d.  Internal  part  of  the  inferior  semilunar  lobe,  e  Sff.  Superior  vermiform 
process,  g.  Commencement  of  the  valley,  h.  Pons  Varolii.  i.  Superior  fossa  of  the  cerebellum. 

The  deeper  furrows  form  the  boundaries  of  the  lobes,  the  shallower 
ones  of  the  lobules:  this  arrangement  is  best  seen  by  a  vertical  section 
(fig.  102).  The  central  portion  of  this  surface  being  elevated,  has  been 
described  by  some  authors  as  a  distinct  process,  the  superior  vermiform 
process  (103,  e).  This  portion  of  the  cerebellum  has  been  described  by 
Reil  as  a  commissure,  but  it  does  not  appear  to  me  to  be  an  apparatus 
of  union,  but  rather  a  centre  of  power  placed  in  the  mesial  line,  and 
connected  laterally  with  the  two  hemispheres,  perfectly  analogous  to  the 
cerebellum  of  all  animals  below  the  Mammalia.  Reil,  himself,  states 
that  in  the  brain  of  the  hare  there  is  little  more  than  a  vermiform  pro- 
cess. Indeed  a  mere  section  of  it  ought  to  be  sufficient  to  convince  us 
that  it  is  no  true  commissure.  Comparative  anatomy  has  shown  us  that 
this,  the  central  lobe,  is  the  fundamental  portion  of  the  cerebellum.  The 
lamina?  of  it  curve  forwards,  while  those  of  the  lateral  lobes  on  each 
side  curve  backwards. 

Viewing  the  superior  surface  of  the  cerebellum,  we  observe  the  lateral 
lobes  are  again  subdivided  (103)  by  a  deep  fissure,  into  a  lobe  of  a 
square  shape  (6),  situated  anteriorly;  and  a  semicircular-shaped  lobe  (c) 
on  the  posterior  margin.  The  lobulus  quadratus  is  bounded  by  the  fis- 
sure of  the  anterior  margin,  the  semilunar  fissure  of  Reil,  in  which  is 
situated  the  pons  Varolii. 

At  the  posterior  extremity  of  the  superior  surface  a  deep  and  wide 
notch  also  occupying  the  mesial  line  may  be  observed.  This  notch, 
called  by  Reil  the  purse-like  fissure,  divides  the  cerebellum  into  two 
lateral  lobes  or  hemispheres,  as  they  are  sometimes  called,  as  will  be 
more  distinctly  seen  by  reversing  the  position  of  the  cerebellum.  Sepa- 
rating the  under  from  the  upper  surface,  there  is  a  very  deep  horizontal 
fissure  (fig.  104,  c).  Looking  at  the  under  surface  of  the  cerebellum 


CEREBELLUM.  219 

and  medulla  oblongata  when  they  are  removed  together  from  the  rest  of 
the  brain,  we  observe  first  the  medulla  oblongata  lying  in  this  mesial 
furrow,  the  valley.  Raising  the  medulla  and  turning  it  forwards,  we 
next  observe  another  worm-like  process,  the  processus  vermiformis  info- 

Fig.  104. 


Inferior  surface  of  the  cerebellum.  The  medulla  oblongata  is  cut  away  close  to  the  pons  Varolii.  a  a. 
Lateral  lobes,  b.  Anterior  and  external  part  of  the  semilunar  and  square  lobes,  c.  Great  horizontal  fis- 
sure, d.  Inferior  semilunar  lobe.  e.  Slender  lobe.  /.  Biyentral  lobe  g.  Tonsilla  lobes,  or  amygdala. 
h.  Flocculus,  i.  Its  white  substance,  k.  The  spigot,  or  inferior  vermiform  process,  almost  covered  by 
the  tonsils,  or  amygdala.  1.  Nodules,  m.  Pyramid,  n.  Pons  Varolii,  or  commissure  of  the  cerebel- 
lum, o  o.  Crura  cerebelli. 

rior,  connecting  the  two  lateral  lobes,  and  partly  filling  up  the  valley. 
This  vermiform  process  is  laminated  in  the  same  manner  as  the  lateral 
lobes  ;  it  is  divided  by  Reil  into  three  portions ;  the  posterior  he  calls 
the  pyramid  (fig.  104,  m),  the  middle,  the  spigot ;  and  the  anterior,  the 
nodule  (fig.  104,  /).  The  fissures  in  this,  the  under  surface,  are  much 
deeper  than  in  the  upper.  Their  direction  at  the  anterior  part,  instead 
of  being  from  side  to  side,  is  from  before  backwards,  cutting  so  deeply 
into  its  substance  that  Reil  has  described  the  intermediate  portions  as 
distinct  lobes.  Each  lateral  lobe  or  hemisphere  of  the  cerebellum  has 
five  lobes;  the  most  anterior  and  inferior  of  these  portions  is  the  small- 
est ;  it  is  more  separated  than  the  rest,  and  stands  out  from  the  inferior 
edge  of  the  pons  Varolii  close  to  the  corpus  restiforme,  like  a  cauliflower 
on  a  stalk.  This  first  lobe  is  called,  by  Reil,  the  flock  (fig.  104,  A),  and 
stated  to  be  absent  in  the  lower  animals.  Immediately  behind  the  flock, 
lying  in  contact  with  the  restiform  bodies  of  the  medulla  oblongata,  is 
the  tonsil-shaped  lobe,  or  amygdala  of  Reil  (g1);  the  next  division  in 
succession  as  we  pass  backwards  is,  Thirdly.  The  biventral  lobes 
(fig.  104,  e),  which  lie  between  the  slender  lobes  and  the  amygdala. 
Fourthly.  The  slender  lobes  (e).  Fifthly.  The  under  and  posterior  semi- 
lunar  lobes  (d). 

A  view  of  the  posterior  surface  is  also  very  instructive,  as  exhibiting 
the  above-mentioned  lobes  from  a  different  point  of  sight  (fig.  105). 
From  this  general  view  of  its  configuration  the  student  must  proceed  to 
the  more  difficult  and  important  question  of  its  internal  structure.  First, 
the  arrangement  of  its  gray  neurine  which  forms  its  ganglionic  portion. 


220  HUMAN    BRAIN. 

The  arrangement  of  the  gray  neurine  in  the  cerebellum  is  beautifully 
simple,  for,  with  one  exception,  it  is  entirely  on  the  surface.  This  layer, 
like  the  hemispherical  ganglia,  or  the  cortical  substance  of  the  hemi- 
spheres, is  of  immense  extent,  requiring  in  the  same  manner  to  be  folded 
up  in  order  to  pack  it  into  the  small  space  devoted  to  its  reception. 
The  term  laminated  ganglion  of  the  cerebellum  might  be  advantageously 
employed  to  designate  it. 

Fig.  105. 


Posterior  surface  of  the  cerebellum  and  spinal  cord.  a.  Spinal  cord.  «.  Amygdala,  f.  Biventral 
lobe.  g.  Slender  lobe.  h.  Inferior  semilunar  lobe.  i.  Superior  semilunar  lobe.  k.  Square  lobe.  /  4*  m- 
Superior  vermiform  process,  n.  Inferior  ditto,  o.  Pyramid,  ii.  Posterior  roots  of  the  cervical  nerves. 

Its  extent  and  relation  to  the  fibrous  neurine  is  best  seen  by  perpen- 
dicular and  horizontal  sections,  as  directed  further  on. 

The  only  gray  neurine  in  the  interior  of  the  cerebellum  is  deposited  a 
little  on  each  side  of  the  mesial  line,  very  near  to  the  centre.  It  is  a 
curious  waving  surface,  presenting  both  in  a  perpendicular  and  hori- 
zontal section  a  denticulated  appearance,  very  like  that  in  the  interior 
of  the  corpus  olivare,  only  rather  more  than  twice  its  extent  (fig.  92). 

This  body,  long  known  as  corpus  rhomboidum,  corpus  dentatum,  ker- 
nel of  the  cerebellum,  &c.,  was  denominated  by  Spurzheim  the  ganglion 
of  the  cerebellum. 

"Vicq  d'Azyr,"  says  this  author  (see  p.  121), ,  "  believed  that  the 
ganglion  of  the  cerebellum  was  only  to  be  found  in  the  human  kind. 
But  in  1808,  conjointly  with  Dr.  Gall,  I  showed  that  it  exists  in  the 
Mammalia  generally ;  and  I  now  add,  that  it  is  very  distinct  in  birds. 
Whenever  the  cerebellum  is  somewhat  considerable,  it  may  always  be 
demonstrated  ;  its  small  size  and  pale  color  were  probably  the  causes  of 
its  existence  being  overlooked.  But  it  is  matter  of  prime  importance 
not  to  confound  the  forms  assumed,  and  the  lighter  or  deeper  shades  of 
color  possessed  by  the  pulpy  substance,  with  its  necessary  existence." 

I  think  that  the  better  title,  one  more  in  accordance  with  the  principle 
of  nomenclature  already  advocated,  would  be  Ganglion  dentiforme. 

Reil  (p.  33,  Mayo's  Physiol.  Com.)  compares  the  laminated  arrange- 
ment of  the  medullary  and  cineritious  matter  of  the  cerebellum  to  the 


CEREBELLUM.  221 

u  plates  of  a  voltaic  pile."  I  do  not  see  the  correctness  of  this  simile. 
Indeed,  this  arrangement  seems  rather  a  necessary  part  of  that  admira- 
ble contrivance  which  we  observed  carried  out  in  the  hemispheres  of 
the  cerebrum,  for  obtaining  an  extensive  surface  of  gray  neurine  placed 
upon  and  in  close  connection  with  a  corresponding  amount  of  white 
fibres  ;  inasmuch  as  the  gray  neurine  being  supposed  to  generate  power, 
requires  an  adequate  supply  of  conducting  instruments  in  the  white 
fibres  for  the  exportation  of  its  power,  or  the  importation  of  a  stimulus 
to  its  production. 

The  student  may  first  study  the  white  fibres  of  the  cerebellum  merely 
anatomically,  reserving  for  future  consideration  the  physiological  ques- 
tion, which  of  them  belong  to  the  motor,  sensory,  or  commissural  tracts. 
Speaking  metaphorically,  and  without  reference  to  their  offices  or  the 
course  of  nervous  power,  they  are  derived  from  six  sources,  three  on 
each  side. 

The  collected  bundles  from  which  we  are  supposing  them  to  emanate 
external  to  the  cerebellum,  are  described  as  the  peduncles  of  the  cere- 
bellum, and  named  from  their  position,  superior,  inferior,  and  middle 
peduncles.  These  terms,  though  unphysiological,  it  is,  perhaps,  con- 
venient to  retain. 

The  great  transverse  commissure  of  the  cerebellum,  or  pons  Varolii, 
had  better  first  engage  the  student's  attention.  In  his  previous  dissec- 
tions he  has  observed  how  the  anterior  and  posterior  columns  of  the 
cord  traverse  its  central  portion.  Now  he  must  follow  out  the  lateral 
portions,  crura  cerebelli  of  old  authors,  which  plunge  into  the  substance 
of  the  cerebellum.  Let  him  reverse  its  position  and  place  the  pons  Va- 
rolii upon  its  under  surface,  and  raise  with  the  fingers  all  those  laminaB 
of  the  cerebellum  which  overlap  it  as  it  enters  this  ganglion.  And  by 
taking  a  pinch,  if  I  may  so  say,  of  these  laminaB,  and  tearing  them  up- 
wards and  inwards,  the  course  of  the  fibres  of  this  the  middle  peduncle 
of  the  cerebellum  will  be  seen  spreading  in  all  directions,  and  running 
into  each  separate  lamina  both  of  the  superior  and  inferior  vermiform 
process  and  the  lateral  lobes.  The  same  mode  of  dissection  pursued  at 
the  under  surface  will  expose  them,  running  equally  to  all  parts  of  the 
cerebellum,  including  the  inferior  vermiform  process  (fig.  104). 

Indeed,  if  there  is  one  point  in  the  anatomy  of  the  cerebellum  on 
which  I  feel  more  certain  than  another,  it  is  the  fact  that  the  fibres  of 
the  pons  Varolii  are  in  connection  with  the  whole  of  the  laminated  gan- 
glion or  cineritious  surface  of  the  cerebellum. 

They  do  not  appear  so  intimately  connected  with  the  dentiform  gan- 
glion as  those  of  the  superior  peduncle,  but  I  am  not  able  to  say  that 
they  do  not  pass  through  it. 

The  inferior  peduncles  are  the  corpora  restiformia,  or  processus  e 
cerebello  ad  medullam  oblongatarn,  consisting,  as  before  stated,  of  motor 
and  sensory  fibres.  The  best  mode  of  following  them  to  their  destina- 
tion is  to  raise  the  auditory  nerve  (fig.  108)  just  at  the  lower  edge  of  the 
pons  Varolii,  and  by  turning  it  down  carefully  with  a  probe  its  iwo  roots 
which  embrace  the  restiform  body  will  be  seen,  and  that  body  distinctly 
exposed  just  as  it  plunges  into  the  cerebellum,  where  it  will  be  found 
to  pass  upwards,  beneath,  and  to  the  inner  side  of  the  crus  cerebelli  or 


222  HUMAN   BRAIN. 

lateral  portion  of  the  pons  Varolii,  from  which  it  may  easily  be  separated 
by  a  probe. 

I  prefer  a  probe,  or  any  narrow  blunt  instrument,  for  dissecting  the 
brain,  as  less  liable  to  deceive  you  with  regard  to  the  existence  and  di- 
rection of  fibres. 

The  student  should  next  divide  the  whole  of  the  transverse  commis- 
sure or  crus  cerebelli,  carefully  avoiding  the  inferior  peduncle,  or  resti- 
form  body  ;  and  tearing  this  commissure  in  the  same  direction  as  before, 
upwards  and  inwards,  the  fibres  of  the  restiform  body  will  be  seen  run- 
ning to  both  the  inferior  and  superior  vermiform  process  and  the  posterior 
laminae  of  the  lateral  lobes.  But  here,  as  in  the  case  of  the  superior 
peduncle,  I  cannot  state  positively  the  extent  of  the  connections  of  the 
fibres  of  the  restiform  bodies ;  but  my  belief  is  that  they  do  not  pass 
laterally,  or  reach  the  surface  of  the  lateral  lobes. 

And  it  is  most  probable  that  such  is  the  arrangement,  considering  the 
fact  that  the  lateral  lobes  of  the  cerebellum  are  deficient  in  those  ani- 
mals in  whom  the  pons  Varolii  is  wanting,  and  extremely  small  in  all 
animals  except  in  man,  in  whom  alone  the  pons  Varolii  attains  any  size 
at  all. 

The  superior  peduncle  of  the  cerebellum  has  been  already  referred  to 
as  the  inter-cerebral  commissure,  or  processus  e  cerebello  ad  testes.  Its 
component  fibres  are,  however,  twofold,  as  before  stated :  one  portion 
of  them  truly  commissural,  connecting  the  cerebrum  and  cerebellum 
together;  the  other  is  derived  from  the  motor  tract.  The  fibres  of 
this,  the  superior  peduncle,  may  be  traced  into  the  substance  of  the 
cerebellum  by  first  raising  those  laminaB  of  its  superior  vermiform  pro- 
cess, which,  overlapping  this  body,  are  in  apposition  to  the  optic 
tubercles.  Next  tearing  up  carefully  one  lamina  after  another,  the  fibres 
of  this  peduncle  will  be  seen  to  pass  in  the  leaflets  of  this  vermiform 
process. 

To  the  outer  side  of  this  process  they  are  found  running  through  the 
ganglion  dentiform  of  the  cerebellum  to  the  posterior  laminaB,  and  I  have 
not  yet  been  able,  by  the  most  careful  dissections,  to  satisfy  myself  that 
these  fibres  spread  into  the  lateral  lobes  so  as  to  reach  the  lateral  lamina. 
In  this  portion  of  their  course  they  are  overlaid  by  that  thick  layer  of 
fibres  from  the  pons  Varolii  which  sweep  round  from  the  outer  side  of 
the  cerebellum  to  the  superior  vermiform  process.  The  remaining  fibres 
of  this  peduncle  pass  to  the  inferior  vermiform  process;  these  may  be 
easily  traced  after  making  a  perpendicular  section  through  the  centre  of 
the  cerebellum. 

Those  fibres  of  this  peduncle,  which  are  apparently  derived  from  the 
motor  tract,  will  be  most  clearly  demonstrated  by  dividing  the  cerebel- 
lum into  two  halves,  then  dividing  close  to  the  cerebellum  that  portion 
of  the  pons  Varolii  called  the  crus  cerebelli,  and  the  corpus  restiforme. 
If  the  cerebellum  be  now  raised,  tearing  up  the  inter-cerebral  commis- 
sure, it  will  be  found  that  some  of  its  fibres  descend,  and  in  so  doing 
interlace  with  the  ascending  fibres  of  the  sensory  tract;  these  descending 
fibres  may  be  traced  through  the  locus  niger  of  the  crus  cerebri  till  they 
become  continuous  with  the  motor  tract. 

The  physiological  analysis  of  the  cerebellar  fibres  is  simple :    First, 


CEREBELLUM.  223 

there  are  transverse  commissural  fibres  in  the  shape  of  the  pons  Varolii,  or 
great  transverse  commissure,  connecting  the  whole  corresponding  sur- 
face of  the  ganglion  of  the  cerebellic  hemispheres.  Secondly,  longitu- 
dinal coramissural  fibres,  the  inter-cerebral  commissure  connecting  the 
cerebrum  and  cerebellum.  Thirdly,  motor  fibres  passing  from  the 
cerebrum  in  common  with  the  rest  of  the  motor  tract  through  the  cor- 
pus striatum,  or  crus  cerebri,  entering  into  the  composition  of  the 
superior  peduncle  and  terminating  in  the  superior  and  inferior  vermi- 
form processes.  Fourthly,  motor  fibres  emanating  from  the  superior 
and  inferior  vermiform  processes,  entering  into  the  composition  of  the 
restiform  bodies,  and  joining  the  anterior  portion  of  the  cord,  as  the 
cerebellic  fibres  of  the  anterior  columns.  Fifthly,  and  lastly,  sensory 
fibres  from  the  posterior  columns  of  the  cord,  forming  likewise  a  por- 
tion of  the  restiform  bodies,  and  terminating  in  the  two  vermiform  pro- 
cesses. 

Let  the  student  now  call  to  mind  the  simple  form  in  which  the  cere- 
bellum was  first  presented  to  his  notice.  In  the  carp,  he  saw  it  as  a 
mere  rounded  point;  in  the  whiting,  a  narrow  leaflet  or  tongue;  in  the 
skate,  advanced  so  as  to  form  two  larger  or  more  distinct  leaflets  ;  in  the 
tortoise,  much  larger,  and  hollowed  out  internally;  and  in  the  bird,  so 
much  further  advanced  as  to  assume  a  true  laminated  character. 

"The  cerebellum  of  the  bird,"  (says  Reil,  p.  205,  whose  account  of 
the  development  of  this  organ  I  have  followed  almost  literally,  and 
which  will  be  found  peculiarly  interesting  to  the  student  after  he  has 
thoroughly  mastered  its  anatomy  in  the  human  subject,)  "  represents  in- 
deed a  vermiform  process  alone,  and  wants  the  lateral  parts,  which  are 
superadded  in  animals  more  nearly  allied  to  human  beings  in  their 
anatomical  construction,  possessing  in  their  place  little  germs  or  shoots 
scarcely  discernible. 

"The  successive  additions,  which  may  be  traced  to  this  simple  form 
of  a  cerebellum,  are  of  a  similar  structure  with  the  elementary  part:  and 
those  additions  which  adhere  with  the  primitive  portion  by  medullary 
substance  alone,  being  otherwise  separate  and  distinct,  are  termed  offsets 
(Ansatze) ;  those  which  are  connected  both  by  medullary  and  cortical 
substance  are  termed  wings  (Flugeln)  of  the  vermiform  process.  Among 
the  lower  animals,  there  are  but  few  and  simple  offsets  ;  higher  in  the 
scale,  these  become  more  numerous;  the  vermiform  process  extends 
itself  laterally  and  receives  wings,  and  in  proportion  as  the  wings  are 
developed,  the  offsets  diminish.  The  first  improvement  in  the  cere- 
bellum takes  place  at  its  anterior  and  upper  surface;  while  on  its  under 
surface  the  parts  remain  contracted  and  sunken.  The  vermiform  pro- 
cesses predominate  even  in  quadrupeds,  in  length,  breadth,  and  depth; 
the  fore  part  only  of  the  cerebellum  possesses  distinct  wings  ;  laterally 
and  behind,  there  are  only  offsets.  In  proportion  as  the  fabric  improves, 
the  offsets  are  changed  into  wings,  till  at  length  in  human  beings  the 
hemispheres  are  completed  ;  and  with  the  exception  of  the  flocks,  the 
offsets  have  wholly  disappeared.  All  the  parts  are  now  brought  together 
in  compact  order:  the  vermiform  processes,  with  their  wings,  constitute 
one  whole,  between  the  parts  of  which  the  freest  communication  seems 
to  exist,  which  the  employment  of  offsets  would  interrupt. 


224  HUMAN    BRAIN. 

"  In  the  brain  of  the  hare  there  is  little  more  than  a  vermiform  pro- 
cess: there  are  but  few  wings,  and  these  slight  and  short:  the  lateral 
offsets  are  small.  In  the  brain  of  the  sheep  the  central  lobe  is  large, 
firm  and  broad,  but  has  neither  wings  nor  offsets:  the  anterior  velum  is 
somewhat  depressed  upon  the  fourth  ventricle.  The  next  lobe  in  order 
is  broad,  of  some  length  and  depth,  but  has  laterally  short  projections, 
not  equal  in  their  breadth  to  half  the  length  of  the  vermiform  process; 
these,  however,  may  be  viewed  as  wings.  In  the  third  lobe  the  organ 
is  contracted,  and  has  longer  and  larger  wings ;  there  follow,  upon  the 
under  surface,  a  pyramid,  spigot,  and  nodule,  which  have  no  wings,  but 
a  large  bundle  of  lateral  offsets ;  between  the  wings  and  offsets  the 
peduncles  of  the  annular  protuberance  emerge,  and  mark  the  place  of 
the  horizontal  fissure.  The  whole  cerebellum  has  a  globular  form,  which 
results  from  the  projection  of  the  vermiform  processes.  The  latter  stand 
more  or  less  vertically  over  the  medulla  oblongata,  and  have  an  anterior 
and  a  posterior  surface,  which  correspond  with  the  superior  and  inferior 
surfaces  of  the  same  parts  in  the  human  brain.  The  lateral  offsets  in 
the  higher  animals  are  more  and  more  driven  from  the  fore  to  the  back 
part  of  the  cerebellum,  until  at  length,  in  the  human  brain,  they  are  ex- 
changed for  the  lobes  of  the  inferior  surface,  which  unite  with  the  inferior 
vermiform  process.  The  whole  cerebellum  seems,  indeed,  pressed  back- 
wards, as  its  parts  become  more  complex  ;  so  that  the  central  lobe  con- 
tinually emerges  more  and  more  from  between  the  peduncles  of  the 
tubercula  quadrigemina,  and  in  the  human  brain  lies  fairly  behind  these 
bodies,  the  common  anterior  stem  being  directed  upwards,  and  the 
posterior  horizontally.  In  the  brain  of  the  ox  the  central  lobe  is  large, 
and  without  wings;  the  remaining  lobes  of  the  anterior  surface  are  of 
inconsiderable  dimensions:  on  the  posterior  surface,  the  pyramid,  spigot, 
and  nodule  are  barely  separable;  they  are  without  wings,  and  have 
scarcely  offsets.  Lastly,  in  the  brain  of  the  horse  the  central  lobe  is 
large,  and  without  wings,  but  of  less  size  than  in  the  ox,  and  more  com- 
pressed from  above  downwards.  The  next  lobes  of  the  vermiform  pro- 
cess have  anteriorly  larger  and  longer  wings,  which  are  bent  forwards, 
contracted  in  their  middle,  and  at  their  ends  have  a  club-like  thickening. 
The  upper  and  posterior  lobe  is  distinct;  but  the  under  and  posterior, 
the  slender,  the  biventral,  and  almond-like  lobes,  are  wanting,  and  in 
their  stead  a  large  bundle  of  irregular  offsets  is  found  on  either  side  of 
the  pyramid,  the  spigot,  and  the  nodule. 

"Thus  the  enlargement  of  the  cerebellum  proceeds  from  the  central 
primary  portion ;  to  which  new  processes,  as  wings  or  offsets,  are  con- 
tinually added,  in  proportion  as  the  scale  of  its  improvement  rises.  In 
quadrupeds,  and  even  in  the  human  brain,  traces  of  the  simplest  type 
of  a  cerebellum  are  to  be  seen  in  the  central  lobe,  illustrating  further  the 
principle  on  which  its  improvement  proceeds.  The  furrow  between  this 
lobe  and  the  lateral  processes  connected  with  it  is  so  deep,  as  to  leave 
it  doubtful  whether  the  latter  are  properly  wings  or  offsets. 

"  In  the  human  brain  the  wings  form  the  principal  part  of  the  cerebel- 
lum, viz.  the  hemispheres.  On  the  upper  surface  these  are  immediately 
prolonged  from  the  vermiform  process;  on  the  under  surface  they  seem 
incomplete,  being  separated  by  a  deep  furrow  from  the  inferior  vermi- 


CEREBELLUM.  225 

form  process  on  either  side.  It  is  remarkable  that  the  human  cerebel- 
lum, the  most  complex  in  its  structure  of  any,  should  yet  exhibit  a 
resemblance  of  the  clearest  kind  to  the  primitive  and  elementary  form. 
When  the  human  cerebellum  is  placed  with  its  usually  horizontal  axis 
in  a  vertical  direction,  it  may  be  rigorously  compared  with  the  cerebel- 
lum of  birds:  what  in  the  latter  case  is  a  single  lamina,  is  here  subdi- 
vided, and  has  become  arborescent ;  in  the  one  case  single  leaves,  in  the 
other,  lobes,  lobules,  and  finally  leaves,  are  raised  around  the  nucleus, 
forming  a  dense  investment  to  it,  from  under  which  the  peduncles  pro- 
ject on  each  side,  like  the  fin-like  feet  from  under  the  shell  of  the  turtle. 

"  In  proportion  as  the  lateral  parts  increase  in  the  shape  of  offsets  or 
wings,  the  vermiform  processes  become  smaller,  as  if  compressed  to- 
wards the  centre.  This  circumstance  is  most  apparent  in  the  human 
brain :  the  vermiform  processes  are  there  comparatively  diminutive  in 
every  dimension,  in  length,  breadth,  and  depth:  before  them  spring  out 
the  horns  of  the  semilunar  fissure,  behind  them  the  projecting  margin 
of  the  purse-like  fissure  :  within  the  latter,  and  at  the  place  of  the  spigot 
and  nodule,  the  inferior  vermiform  process  is  scarcely  a  few  lines  in 
breadth.  In  animals  the  vermiform  processes  overtop  the  lateral  por- 
tions; in  man  the  upper  surface  of  the  general  commissure  is  only  on  a 
level  with  the  hemispheres,  while  below  it  is  contracted  and  shrunken 
to  the  bottom  of  the  valley.  This  compression  of  the  general  commis- 
sure on  all  sides  in  the  human  brain,  accounts  for  the  difference  observ- 
able in  its  structure  as  compared  with  that  of  the  hemispheres  ;  a  differ- 
ence which  is  not  found  in  the  brains  of  quadrupeds.  In  its  texture  this 
part  in  the  human  brain  is  softer,  and  its  membrane  firmer  and  more 
vascular  than  is  the  case  in  the  hemispheres.  The  medullary  matter  is 
here  again  in  thinner  layers  than  in  the  hemispheres ;  thinly  spread  out 
in  the  anterior  velum,  it  forms  a  thicker  mass  at  the  meeting  of  the  ver- 
tical and  horizontal  process,  where  the  nucleus  of  the  general  commis- 
sure begins :  in  the  former  process  it  exists  in  greater  quantity  than  in 
the  latter,  and  finally  it  forms  an  extremely  thin  layer  in  the  posterior 
velum.  In  the  anterior  fissure  the  general  commissure  has  its  greatest 
breadth,  becoming  narrower  as  it  passes  towards  the  purse-like  fissure: 
in  the  single  commissure,  where  it  has  shrunk  to  a  single  lamina,  and  in 
the  short  commissure,  it  continues  still  narrow ;  it  becomes  broader 
again  at  the  pyramid,  and  finally  tapers  to  a  point  in  the  spigot  and  nodule. 
On  either  side  of  the  superior  vermiform  process  there  are  furrows  of 
greater  or  less  depth,  at  which  the  laminae  are  thinner,  and  indented, 
and  their  direction  altered  ;  so  that  whereas  the  convex  margin  of  the 
laminae  of  the  hemispheres  is  Directed  backwards,  that  of  the  lamin® 
of  the  superior  vermiform  process  loot.?  forward.  In  these  furrows,  by 
which  the  lateral  limits  of  the  superior  vermiform  process  are  defined, 
blood-vessels  are  lodged ;  these  fuwms  are  continued  along  the  valley, 
where  they  become  deeper. 

"  Looking  generally  at  the  vermiform  processes,  we  observe  that 
they  are  composed  of  corresponding  portions  on  either  side  of  the  me- 
dian plane,  that  there  is  no  material  difference  in  the  structure  of  the 
upper  and  under  portions,  and  thus  that  the  whole  is  one  homogeneous 
organ.  We  may  observe  further,  that  whereas  in  birds  these  parts  con- 
15 


226  HUMAN    BRAIN. 

stitute  the  whole  of  the  cerebellum,  and  in  quadrupeds  the  principal 
portion,  in  human  beings,  where  their  relative  bulk  is  trifling,  compared 
with  that  of  the  hemispheres,  they  are,  on  the  one  hand,  parts  of  the 
same  composition  and  nature  with  the  latter,  and  on  the  other  may  be 
considered  as  the  general  commissure,  by  which  the  lateral  portions  are 
intimately  united." 

Tuber  Cinereum,  Infundibulum,  and  Pituitary  Gland. — The  only  parts 
of  the  brain  which  now  remain  to  be  noticed,  are  situated  at  its  base, 
namely,  the  tuber  cinereum,  infundibulura,  and  pituitary  gland.  The 
tuber  cinereum  derives  its  names  from  the  cineritious  neurine  of  which 
it  consists,  and  which  entitles  it  to  be  classed  among  the  ganglia.  From 
the  circumstance  of  the  optic  nerve  sending  some  filaments  into  its  sub- 
stance, and  the  longitudinal  commissure  deriving  several  from  it,  I  am 
inclined  to  view  it  as  an  instrument  of  power  connected  in  some  way  or 
other  with  the  phenomena  of  vision.  Its  general  form  has  been  already 
noticed  in  the  description  of  the  base  of  the  brain.  The  infundibulum, 
or  pituitary  process,  is  a  funnel-shaped  tube,  deriving  its  name  from  its 
shape  ;  it  passes  down  from  the  tuber  cinereum  to  the  pituitary  body. 
It  is  hollow,  and  consists  principally  of  cineritious  neurine,  but  internally 
some  white  fibres  may  be  seen  descending  in  a  striated  manner  from  the 
mesial  surfaces  of  the  thalami.  They  are  best  seen  by  means  of  a  glass, 
magnifying  about  ten  diameters.  I  am  inclined  to  regard  this  process 
as  a  medium  of  nervous  communication  or  commissure  between  the 
pituitary  body  and  the  thalami.  The  pituitary  body,  or  gland,  is  sjtu- 
ated,like  the  semilunar  ganglion  of  the  fifth  pair  of  nerves,  external  to 
the  dura  mater.  It  occupies  the  whole  of  the  sella  turcica  of  the  sphe- 
noid bone.  It  weighs,  with  the  infundibulum,  about  eight  grains.  It 
consists  of  two  lobes,  an  anterior  and  posterior.  The  anterior,  which  is 
about  twice  the  size  of  the  posterior,  lodges  the  latter  in  a  hollow  on  its 
posterior  edge. 

The  structure  of  this  body  is  similar  to  the  cineritious  neurine  of  the 
brain  ;  it  is  vesicular,  made  up  of  large  nucleated  cells,  surrounded  by 
a  granular  matter  imbedded  in  a  white  fibrous  tissue.  This  fibrous  tis- 
sue accompanies  the  blood-vessels,  which  are  found  in  it  in  great  num- 
bers. Its  substance  is  soft,  but  not  so  soft  as  the  cerebral  matter,  and 
when  pressed  between  the  fingers,  is  reduced  to  a  grayish  pulp,  like  the 
substance  of  an  absorbent  gland  in  an  early  stage  of  suppuration. 

It  is  larger  in  the  infant  than  in  the  adult,  and  more  developed  in  some 
of  the  Vertebrata  than  in  man.  We  have  already  observed  its  great  size 
in  fish.  Some  anatomists  have  supposed  that  the  pituitary  body  is  the 
cerebral  ganglion  of  the  sympathetic  nerve ;  and  to  me  this  appears  a 
very  probable  hypothesis. 

Dr.  Todd  does  not  consider  it  a  ganglion,  but  says,  "  It  may  with 
more  propriety  be  classed  with  the  glands  without  efferent  ducts ;  and 
from  its  numerous  vessels  and  close  relation  to  part  of  the  venous  sys- 
tem within  the  cranium,  it  may  be  connected  with  the  process  of  absorp- 
tion or  removal  of  the  effete  particles  of  the  brain." 

Recapitulation. — The  description  of  the  course  and  termination  of  the 
various  tracts  of  medullary  neurine  which,  with  their  ganglia,  constitute 
the  brain  or  encephalon,  being  now  concluded,  it  will,  I  think,  be  useful 


RECAPITULATION.  227 

to  take  a  general  review  of  the  subject,  by  a  recapitulation  of  what  has 
been  stated  in  detail  separately ;  and  we  will  reverse  the  order  of  our 
observations,  proceeding  from  above  downwards  instead  of  from  below 
upwards. 

In  the  first  place,  we  have  an  extensive  surface  of  cineritious  neurine, 
the  hemispherical  ganglion,  (speaking  merely  of  one  side  of  the  brain,) 
which,  in  the  higher  orders  of  animals,  is  convoluted  or  folded  in  a 
peculiar  manner. 

In  apposition  to  the  whole  of  the  vesicular  neurine  of  this  ganglion, 
there  are  tubular  fibres  which  radiate  through  it,  and  are  encrusted  by 
its  nucleated  cells. 

These  fibres  are  disposed  of  in  four  different  ways;  1st,  some  of  them, 
commencing  from  the  convolutions  of  the  anterior,  middle,  and  posterior 
lobes,  pass  through  the  corpora  striata,  and,  forming  the  inferior  layer  of 
the  crus  cerebri,  pass  through  the  pons  Varolii,  so  as  to  form  the  ante- 
rior columns  of  the  cord,  as  previously  described — the  motor  tract :  2d, 
others  commencing  in  the  nerves  of  sensation,  and  after  passing  through 
the  pons  Varolii,  and  emerging  from  the  substance  of  the  thalamus, 
terminate  in  the  same  neurine  that  gave  origin  to  the  last ;  this  is  the 
sensory  tract :  3d,  others,  passing  from  one  side  of  the  brain  to  the  other, 
and  in  apposition  to  the  internal  surface  of  all  the  convolutions,  are 
those  fibres  which,  collected  into  a  mass,  form  between  the  hemispheres 
that  wide  bridge,  if  I  may  so  call  it,  the  great  transver&e  commissure,  or 
corpus  callosum:  4thly  and  lastly,  in  contact  with  all  the  convolutions 
are  the  fibres  of  the  superior  and  inferior  longitudinal  commissures, 
which,  connecting  together  those  convolutions  which  are  situated  on  the 
same  side  of  the  mesial  line,  or  different  portions  of  the  same  hemi- 
spherical ganglion,  so  far  differ  from  the  transverse  commissure,  which 
connects  those  situated  on  opposite  sides,  or  the  two  distinct  but  corre- 
sponding ganglia. 

The  first  and  second  set  of  fibres,  which  radiate  from  the  external 
surface  of  the  two  large  ganglia  of  the  anterior  and  posterior  columns, 
as  from  a  common  centre,  forming,  however,  in  their  radiation,  only  half 
a  circle,  were  designated  by  Gall  and  Spurzheim  the  diverging  fibres. 
The  third  set  of  fibres,  which  converge  towards  the  centre  of  the  brain, 
the  transverse  commissural,  were  distinguished  as  the  converging  fibres 
by  the  same  authors. 

The  above  descriptions  demonstrate  that  the  encephalon  or  brain  in 
the  human  subject  is  not  a  large  solid  mass  of  matter,  in  the  interior  of 
which  are  cavities  scooped,  as  it  were,  out  of  its  substance,  to  be  appro- 
priately  denominated  ventricles,  but  that  it  really  consists  of  ganglia  or 
collections  of  cineritious  neurine,  placed  on  each  side  of  the  mesial  line. 
Some  of  them  being  the  appropriate  ganglia  of  the  nerves  of  sensation ; 
as,  for  instance,  the  olfactory  ganglia,  the  optic  ganglia  or  tubercula 
quadrigemina,  the  auditory  ganglia  or  posterior  pyramidal  bodies,  the 
pneumogastric  ganglia  or  restiform  ganglia,  the  olivary  bodies  or  lingual 
ganglia  ;  the  others  being  the  motory  and  sensory  ganglia,  as  the  corpora 
striata  and  thalami  nervorum  opticorum.  The  hemispherical  ganglia, 
again,  that  they  might  present  the  greatest  possible  extent  of  surface,  are 
folded  up  into  innumerable  plaits,  and  thus  cover  or  surround  every  other 


228  HUMAN    BRAIN. 

ganglion  within  the  cranium,  so  that  on  first  removing  the  skull-cap,  no- 
thing can  be  seen  but  the  convoluted  surface  of  these  extensive  ganglia. 

And  here  let  me  insist  upon  this  important  principle  in  the  study  of 
the  brain,  which  is  also  one  of  the  first  ideas  that  the  student  should 
acquire  regarding  its  composition,  namely,  that  it  consists  of  correspond- 
ing or  symmetrical  parts  on  each  side  of  the  mesial  plane,  and  that  in- 
stead of  regarding  the  fissures  of  separation  between  its  different  portions 
as  forming  ventricles  or  cavities,  he  must  direct  his  attention  to  the 
ganglia  which  bound  the  fissure,  and  the  structures  called  commissures, 
which,  connecting  them  together,  cross  the  fissure,  and  necessarily  alter 
its  character  in  different  points,  masking  it,  it  is  true,  but  not  at  any  place 
changing  the  fissure  into  a  true  bag  or  circumscribed  cavity.  The  third, 
the  iter  a  tertio  ad  quartum  ventriculum,  the  fourth  and  fifth  ventricles, 
we  have  already  seen,  are  in  truth  no  more  than  the  successive  dilata- 
tions from  below  upwards  of  the  posterior  fissure  of  the  cord ;  difficult 
enough  to  be  understood  when  these  are  viewed  in  different  situations 
and  unconnected  one  with  the  other,  as  in  the  ordinary  mode  of  dissect- 
ing the  brain,  but  which  seem  necessary  and  obvious  where  its  parts  are 
traced  in  connection  with  one  another. 

In  conclusion,  let  me  express  the  hope  that  these  views  or  analyses,  if 
I  may  be  allowed  so  to  call  them,  of  the  component  parts  of  the  ence- 
phalon,  will  really  simplify  the  whole  of  its  anatomy,  and  materially  assist 
the  student  in  acquiring  a  knowledge  of  its  true  character.  I  wish  that 
custom  did  not  require  the  student  to  burden  his  memory  with  fanciful 
and  unmeaning  names,  and  that,  instead  of  learning  a  long  catalogue  of 
the  contents  of  the  lateral  ventricles,  as  they  are  erroneously  designated, 
and  puzzling  himself  with  the  absurd  titles  of  hippocampus  major  and 
minor,  pes  hippocampi,  tcenia  hippocampi,  cornu  Ammonis,&c.,  he  should 
be  required  simply  to  observe  how  the  spinal  columns  appear  to  terminate 
superiorly  in  two  large  tubercles,  the  corpora  striata  and  thalami^  from 
the  sides  and  under  parts  of  which  the  hemispheres  spring  out,  being 
afterwards  reflected  so  as  completely  to  envelop  this  bulbous  extremity 
of  the  spinal  cord.  In  the  same  way  the  third  ventricle  should  be  de- 
scribed as  a  fissure  separating  the  two  halves  of  the  brain,  his  particular 
attention  being  directed  to  the  commissures  which  pass  across  it  to  con- 
nect the  different  cerebral  ganglia  with  one  another.  The  description 
of  the  relative  position  of  these  ganglia,  the  commissures  connecting 
them,  and  their  relation  to  the  ganglia  and  columns  of  the  spinal  cord, 
comprehend  all  the  information  which  is  either  interesting  or  useful  to 
the  student. 


229 


PART   VII. 

CEREBRAL  NERVES, 

HAVING  thus  considered  both  individually  and  collectively  the  various 
centres  of  power  which  constitute  the  encephalon  in  man,  we  shall  next 
direct  our  attention  to  the  connections  of  the  cerebral  nerves,  organs 
which  conduct  the  mandates  of  the  will  outwards,  and  the  different  per- 
ceptions inwards. 

Connected  with  the  encephalic  ganglia,  and  that  portion  of  the  motory 
and  sensory  tract  which  is  contained  within  the  skull,  there  are,  accord- 
ing to  some  authors,  eleven  pairs  of  nerves ;  in  the  opinion  of  others, 
no  more  than  nine.  Each  nerve  is  distinguished  by  an  appropriate 
name  in  addition  to  its  title  derived  from  its  numerical  position.  This 
difference  in  the  number  of  nerves  reckoned  by  different  anatomists, 
arises  from  the  fact  that  some  describe  the  7th  pair  or  facial,  and  the 
8th  pair  or  auditory,  as  if  they  were  merely  portions  of  the  same  nerve, 
whose  office  was  analogous  although  their  distribution  might  be  differ- 
ent; whereas  the  fact  is  that  they  are  as  distinct  instruments  of  two  dis- 
similar kinds  of  nervous  power  as  the  optic  nerve  and  the  olfactory 
nerve,  and  are  therefore  equally  well  entitled  to  appropriate  and  dis- 
tinguishing appellations.  If  it  is  found  convenient  to  employ  numerical 
names  in  speaking  of  the  cerebral  nerves,  it  is  still  very  important  that 
no  single  number  should  be  given  to  two  nerves  physiologically  distinct, 
however  closely  they  may  be  connected.  The  glosso-pharyngeal  and 
pneumogastric  nerves  have,  also, 'like  the  auditory  and  facial,  been  till 
lately  described  as  forming  the  8th  pair  of  cerebral  nerves.  In  this  in- 
stance we  are  not  perhaps  authorized  to  separate  these  two  nerves  from 
any  decided  proofs  of  their  having  distinct  functions  ;  on  the  contrary, 
we  are  rather  led  to  regard  the  two  as  mere  portions  of  the  conducting 
instrument  of  one  and  the  same  nervous  power.  Nevertheless,  as  one 
division  or  root  of  the  old  8th  pair  is  now  invariably  described  under 
the  title  of  the  pneumogastric ,  and  the  second  division  is  constantly 
spoken  of  by  the  name  of  the  glosso-pharyngeal  when  they  have  passed 
out  of  the  cranium,  it  seems  important  that  the  two  should  still  be  dis- 
tinguished by  distinct  numerical  designations  when  within  the  skull. 
Upon  these  grounds  I  shall  follow  the  arrangement  of  Soemmerring,  who 
describes  eleven  pairs  of  cerebral  nerves:  not,  indeed,  that  I  am  alto- 
gether satisfied  of  the  correctness',  in  a  strictly  physiological  point  of 
view,  of  this  procedure,  for  if  it  be  proper  to  separate  the  seventh  and 
eighth  pairs  into  two  nerves  each,  it  would  be  strictly  correct  to  consider 
the  third  pair  and  the  sixth  as  merely  separate  roots  of  the  same  nerve, 


230  HUMAN   BRAIN. 

and  to  describe  the  two  together  by  the  name  of  the  common  oculo-mus- 
cular:  for  the  circumstance  of  the  commissure  of  the  cerebellum  separat- 
ing their  roots  is  merely  accidental  to  their  arrangement  in  a  physiolo- 
gical point  of  view;  but  the  fact  of  their  being  described  as  if  they  were 
distinct  nerves  has  frequently  led  the  student  to  believe  that  they  must 
be  endowed  with  distinct  offices,  and  wonder  why  the  abductor  muscle 
of  the  eye  should  be  supplied  by  a  peculiar  nerve,  while  the  other  mus- 
cles, with  the  exception  of  the  superior  oblique,  receive  their  supply 
from  the  same  source. 

Most  authors,  with  the  exception  of  Spurzheim,  who  fell  into  the 
opposite  mistake,  have  erroneously  described  all  the  cerebral  nerves  as 
originating  in  the  brain.  The  fallacy  of  this  idea,  and  the  vicious 
method  of  description  that  resulted  from  it,  have  been  pointed  out  in 
the  section  on  Comparative  Anatomy,  where  it  has  been  remarked  that 
the  nerves  of  sensation  should  be  described  as  terminating  in  their  ap- 
propriate ganglia,  as  has  actually  been  done  by  Spurzheim,  whilst  the 
nerves  of  motion,  on  the  contrary,  should  be  described  as  originating 
there,  an  extension  of  the  legitimate  mode  of  proceeding  which  Spurz- 
heim neglected  to  enforce. 

If,  after  this  statement  regarding  the  most  correct  method,  in  a  physio- 
logical point  of  view,  of  describing  the  connection  of  the  cerebral  nerves 
with  the  encephalon,  the  student  is  still  desirous  of  information  upon 
each  of  these  individually,  he  will  find  it  useful  to  make  out  a  table  for 
himself,  in  which  he  must  carefully  distinguish  between  the  apparent 
origin — more  properly  point  of  emergence  from,  or  of  entrance  of  the 
nerve  between  the  fibres  of  the  cerebral  mass,  and  the  actual  point  of 
union  between  the  neurine  of  the  nerve  and  that  of  the  cerebral  mass 
itself. 

First  Pair  of  Nerves,  Olfactory. — The  first  pair  of  nerves  (the  numera- 
tion commencing  at  the  anterior  part  of  the  brain)  encountered  are  the 
olfactory  or  nerves  of  smell ;  they  originate  on  the  lining  membrane  of 
the  nose,  and,  entering  the  skull  through  the  cribriform  plate  of  the 
ethmoid  bone,  terminate  in  the  olfactory  tubercles  or  ganglia,  which  are 
situated  in  the  cribriform  fossa?  of  the  same  bone.*  In  man  these  gan- 
glia, whose  minuteness  as  compared  with  those  of  the  horse,  sheep,  cat, 
dog,  indeed  most  of  the  Mammalia,  is  interesting  in  a  physiological 
point  of  view,  are  entirely  concealed  by  the  enormously  developed  hemi- 
spheres.! Each  ganglion  is  connected  to  the  hemispheres  by  a  long 
narrow  commissure,  frequently  designated  a  peduncle,  which,  lodged  in 
a  triangular-shaped  groove,  passes  backwards  till  opposite  the  fissura 
Sylvii,  where  it  splits  into  three  divisions.  The  most  external  of  these, 
which  is  also  the  longest,  and  distinctly  medullary,  runs  down  the  fissura 
Sylvii  to  be  connected  with  the  anterior  extremity  of  the  middle  lobe  : 

*  MM.  de  Blainville  and  Rolando  are  almost  the  only  modern  authors  who  seem  to  be 
aware  of  the  absurdity  of  retaining  the  ordinary  mode  of  describing  these  portions  of  the 
olfactory  apparatus  as  a  nerve ;  in  fact,  as  Rolando  remarks,  we  have  in  this  particular  re- 
trograded from  the  knowledge  of  the  ancients,  who  never  described  them  by  the  title  of 
nerves.  Willis  appears  to  have  been  the  first  to  speak  of  them  in  connection  with  the  cere- 
bral nerves. 

f  In  describing  each  pair  of  nerves,  the  description  will  generally  be  confined  to  one  side 
only,  as  being  simpler  for  the  student  to  follow. 


CEREBRAL    NERVES.  231 

this  portion  of  the  olfactory  peduncle  is  connected  with  the  anterior 
commissure,  as  described  by  Malacarne  in  his  Encephalotomie  et  Micro- 
cephalotomie,  by  Rolando,  and  by  Gall  and  Spurzheim.  The  internal 
is  connected  to  the  posterior  internal  surface  of  the  under  part  of  the 
anterior  lobe.  The  middle,  which  is  the  shortest,  and,  strictly  speaking, 
no  more  than  the  internal  portion  of  the  external,  is  connected  with  the 
posterior  edge  of  the  anterior  lobe  (see  fig.  72). 

Thus  we  see  the  olfactory  ganglion  in  the  human  brain  connected  by 
a  commissure  with  the  cineritious  neurine  of  the  hemispheres,  as  in  the 
lowest  animals,  where  we  have  invariably  observed  each  individual 
ganglion  in  succession  connected  with  the  others. 

The  canal  which  Gall  and  Spurzheim  believed  they  had  discovered 
in  the  interior  of  the  olfactory  commissure  in  man  was  in  all  probability 
formed  under  the  blowpipe  by  the  breaking  down  of  the  cineritious 
neurine  in  its  interior,  in  the  same  manner  as  a  canal  was  formed  in  the 
spinal  cord  by  the  action  of  the  blowpipe  in  the  hands  of  these  anato- 
mists. Tiedemann  observed  the  existence  of  a  canal  in  the  brain  of 
two  idiots,  an  appearance  which,  I  think,  must  be  considered  merely  as 
an  arrest  of  development  at  a  period  corresponding  to  the  permanent 
organization  of  the  part  in  some  fishes. 

Second  Pair.  —  Optic  Nerves, —  The  optic  nerves  commence  in  the 
globe  of  the  eye,  from  a  nervous  expansion  called  the  retina.  After  pe- 
netrating the  choroid  and  sclerotic  coats  of  the  eye,  they  enter  the  skull, 
through  the  foramina  optica  of  the  sphenoid  bone,  on  the  processus 
olivaris  of  which  they  form  a  commissure,  consisting  of  fibres  arranged 
in  the  following  manner.  The  optic  nerve  on  reaching  this  spot 
divides  into  two  sets  of  fibres.  One  passes  over  to  the  opposite  side, 
and  after  decussating  with  the  corresponding  fibres  of  its  fellow,  reaches 
its  cerebral  connections  (as  described  further  on),  on  the  different  side 
of  the  brain  to  the  eye  from  which  it  emanates.  The  other  set  of  fibres 
do  not  decussate,  but  pass  to  the  same  side  of  the  brain  as  the  eye  from 
which  they  are  derived.  This  structure  is  represented  in  fig.  107,  which 
is  taken  from  a  dissection  similar  to  that  figured  by  Mayo,  who  was,  I 
believe,  the  first  who  demonstrated  by  dissection  this  peculiar  arrange- 
ment. 

The  object  of  this  contrivance  is  explicable  on  the  following  prin- 
ciples.* The  rays  of  light  from  any  object,  placed  laterally,  impinging 
upon  the  retina  of  both  eyes,  will  strike  the  outer  side  of  one  eye  and 
the  inner  side  of  the  other. 

Now,  supposing  the  arrangement  just  depicted  to  be  correct,  (and 
there  is  no  reason  for  supposing  it  to  be  otherwise,)  it  follows  as  a  ne- 
cessary consequence,  that  the  outer  and  inner  side  of  each  opposite 
retina  is  formed  by  one  and  the  same  nerve,  a  peculiarity  of  structure 

*  Dr.  Wollaston  (Phil.  Trans,  for  1824),  in  a  paper  entitled,  "On  SemidecussaTion  of  the 
Optic  Nerve,"  suggests  the  probability  of  such  an  anatomical  arrangement  as  affording  an 
explanation  of  the  phenomena  of  single  vision.  His  words  are:  "Without  pretending  to 
detect  by  manual  dexterity  as  an  anatomist,  the  very  delicate  conformation  of  the  nerves  of 
vision,  1  have  been  led,  by  the  casual  observation  of  a  few  instances  of  diseased  vision,  to 
draw  some  inferences  respecting  the  texture  of  that  part  which  has  been  called  the  decus- 
sation  of  the  optic  nerves,  upon  which  I  feel  myself  warranted  to  speak  with  some  con- 
fidence." 


232  HUMAN    BRAIN. 

that  goes  far  to  account  for  the  circumstance  so  often  reasoned  upon, 
viz.,  that  a  single  impression  is  conveyed  to  the  sensorium,  though  each 
eye  receives  the  impression.  Whether  this  mode 
Fig.  106.  Of  accounting  for  it  be  satisfactory  or  not,  the  fol- 

lowing facts  are  extremely  interesting,  and  not 
sufficiently  known,  viz.,  that  in  those  fishes  whose 
eyes  are  placed  so  completely  on  the  side  of  the 
head  that  the  rays  of  light  from  any  given  object 
cannot  impinge  on  both  retina?,  as,  for  instance, 
in  the  cod  and  haddock,  the  optic  nerves,  instead 
of  forming  any  union  or  commissure,  cross  each 

^^^^^  other  completely,  having  a  membrane  interposed 

This  figure  represents  that  between  them  i  in  those  fishes,  again,  whose  eyes 
33^to£S$S3R  are  situated  so  that  even  a  small  portion  of  their 
winThaTbet  $&3E%  retin8B.  correspond,  as  in  the  carp,  we  find  a  few 
dwelt  upon  in  the  body  of  the  commissural  fibres  ;  and  in  those  whose  retinae 

work ;  it  is  taken,  as  well  as  ,    .  .  ,          .  r      \ 

every  other  drawing  of  my  correspond  in  every  point,  as  in  the  skate,  we  find 
pTsseSkJn r?tPwnitonoVhoX£  tne  commissure  as  complete  as  in  the  human  being, 
ever,  be  the  less  valuable  While  engaged  in  the  investigation  of  this  inte- 

from  its  corresponding,  in  the  .  ) p.  o  .  o  .        , 

representation  of  the  fibres,   resting  subject,  by  the  dissection  of  those  animals 

to  that  of  Mr.  Mayo's  in  his         i  •    , T    ,,  ,     '  i  i     i  i       •  i  •.,     T 

folio  work.  i.  other  fibres  which  I  thought  would  best  elucidate  it,  I  was 
^&-SStSSiS^Si^  informed  by  Mr.  Wheatstone,  Professor  of  Natural 
running  from  one  side  of  the  Philosophy  at  King's  College,  that  Prof.  Miiller, 

brain  to  the  other,  and  wholly        /»r»vii«  °  . 

unconnected  with  the  retina,   or  berlin,  had  given  great  attention  to  the  same 

crossing oveTut th^commis-   subject,  and   had  carried   his   observations  much 

PUositeViden  th°se  °nthe  °P~  further  than  I  have  had  any  opportunity  of  doing, 

but  uniformly  confirming  the  opinions  stated  above. 

The  commissure  of  the  optic  nerves  is  not  alone  formed  of  fibres  de- 
rived from  the  retina  of  the  eye  ;  for,  in  addition  to  these,  we  find  a  set 
of  fibres  highly  interesting  to  the  physiologist,  and  wholly  unconnected 
with  the  organ  of  vision.  These  are  strictly  commissural,  and  were 
first  pointed  out  to  me  by  Mr.  Mayo  ;  they  run  from  one  side  of  the  brain 
to  the  other,  forming  in  their  course  a  curve  convex  anteriorly  and  con- 
cave posteriorly;  they  may  easily  be  seen  in  a  human  brain  that  has 
been  hardened  in  spirits.  In  the  mole,  in  which  the  optic  nerves  are 
so  extremely  minute  that  they  have  often  escaped  detection,  and  by 
many  authors  described  as  entirely  wanting,  these  commissural  fibres  are 
found  distinctly  crossing  the  base  of  the  brain,  opposite  the  usual  situa- 
tion of  the  optic  commissure  ;  while  the  small  black  speck,  evidently 
the  rudiment  of  the  eye,  is  supplied  by  a  minute  branch  from  the  fifth 
pair. 

Wenzel,  who  enters  very  fully  into  the  question  regarding  the  compo- 
sition of  the  optic  commissure,  sums  up  in  the  following  words  (p.  126) : 
— "  Parlialis  ergo  nervorum  opticorum  decussatio,  et  evidens  antopsia 
patens  non  ex  solis  nervorum  opticorum,  sed  et  existorum  loci  unionis 
ipsorum,  et  ex  collicorurn  nervorum  opticorum,  ex  simul  sumptorum 
morbosis  afTectionibus  colligitur  :  quamquam  sileant  hac  de  re  Scemmer- 
ring,  Ackermann  et  Michealis.  Conclusio  ista  unica  et  sola  ex  tarn 
multis  observationibus  quas  attulimus  extra  omne  dubium  esse,  nobis 
videtur." 


CEREBRAL    NERVES. 


233 


In  the  paper  already  referred  to  by  Dr.  Wollaston,  I  find  that  he  sup- 
ports his  theory  by  the  reference  to  the  complete  decussation  of  the 
nerves  in  the  sturgeon,  cod,&c.,  where  the  eyes  are  on  each  side  of  the 
head. 

Fig.  107. 


The  drawing  exhibits  the  cerebral  connection  of  all  the  cerebral  nerves  except  the  1st.  It  is  from  a 
sketch  of  my  own  taken  from  two  dissections  of  this  part.  i>.  Posterior  optic  tubercle.  The  generative 
bodies  of  the  thalamus  are  just  above  it.  E.  Cerebellum.  H.  Spinal  cord.  i.  Tuber  cinereum.  K.  Optic 
thalamus  divided  perpendicularly,  w.  Corpus  restiforme.  x.  Pons  Varolii.  bb.  Optic  nerves:  this 
nerve  is  traced  on  the  left  side  back  beneath  the  optic  thalamus  and  round  the  crus  cerebri.  It  divides 
into  four  roots;  the  first  (g  g)  plunges  into  the  substance  of  the  thalamus,  the  next  runs  over  the  external 
geniculate  body  and  surface  of  the  thalamus,  the  third  goes  to  the  anterior  optic  tubercle,  the  fourth  runs 
to  D,  the  testis  or  posterior  optic  tubercle,  c.  Third  pair  common  oculo-rnuscular,  arising  by  two  roots 
like  the  spinal  roots  of  the  spinal  nerves,  the  upper  from  the  gray  neurine  of  the  locus  niger,  the  lower 
from  the  continuation  of  the  pyramidal  columns  in  the  crus  cerebri  and  pons  Varolii.  p  t.  d.  Fourth 
pair,  apparently  arising  from  the  inter-cerebral  commissure  (i  e).  but  really  plunging  down  to  the  olivary 
tract  (o  t)  as  it  ascends  to  the  optic  tubercles,  e  in.  Motor  or  non-ganglionic  root  of  the  fifth  pair,  arising- 
frorn  the  posterior  edge  of  the  olirary  tract,  e.  Sensory  root  of  the  fifth  pair  running  down  between  the 
olivary  tract  and  restiform  body  to  the  sensory  tract  (for  its  exact  connection,  see  fig.  108).  /.  Sixth  pair, 
or  abducens,  arising  from  the  pyramidal  tract,  g.  Seventh  pair,  facial  nerve,  or  portio  dura,  arising  by 
an  anterior  portion  from  the  olivary  tract  and  by  a  posterior  portion  from  the  cerebellic  fibres  of  the  ante- 
rior columns  as  they  ascend  on  the  corpus  restiforme,  w.  h.  Eighth  pair,  portio  mollis,  or  auditory  nerve, 
with  its  two  roots  embracing  the  restifonn  body.  i.  Ninth  pair,  or  glosso-pharyngeal,  and.;.  Tenth  pair, 
or  par  vagum,  plunging  into  the  restifonn  ganglion,  j  J.  Fibres  of  the  optic  nerve  plunging  into  the  thala- 
mus :  immediately  below  these  letters  is  the  corpus  geniculatum  externum.  Ic.  Eleventh  pair,  or  lingual 
nerve ;  the  olivary  body  has  been  nearly  sliced  off  and  turned  out  of  its  natural  position:  some  ofthe 
filaments  ofthe  lingual  nerve  are  traced  into  the  deeper  portion  of  the  ganglion,  which  is  left  in  its  situa- 
tion; others  which  are  the  highest  are  evidently  connected  with  the  pyramidal  tract. 

. 

M.  P.  G.  Pelletan,  "  Memoire  surla  specialite  des  nerves  des  senses," 
1837,  after  describing  this  band,  says,  p.  32,  "  After  their  interlacement 
these  optic  nerves  undergo  such  an  atrophy  that  they  are  not  more  than 
one-twentieth  of  a  millimetre,  the  band  or  chiasma  being  about  six  times 
as  large." 

The  same  author  recommends  the  dissection  of  either  fetal  moles  or 
very  young  ones,  in  whom  the  optic  foramen  is  still  distinct.  "When 


234  HUMAN    BRAIN. 

the  optic  nerve  has  been  well  prepared,  it  is  to  be  seen  leaving  the 
cranium,  and  passing  between  the  fasciculi  of  the  ophthalmic  nerve  of 
Willis,  which  it  accompanies  to  the  eye." 

"  The  mole,"  says  Miiller,  (Elements  of  Physiology,  translated  by 
Dr.  Baly,  p.  767,)  "  has  an  uncommonly  small  optic  nerve,  and  a  very 
delicate  chiasma,  as  Dr.  Henle  has  shown  me." 

Tracing  the  fibres  of  the  optic  nerve  in  man  from  its  commissure,  we 
find  it  a  flattened  band,  which  has  been  designated  the  tractus  opticus. 
The  tractus  opticus  passes  backwards  and  outwards,  running  along  the 
external  margin  of  the  gray  matter  (tuber  cinereum,  figs.  72  and  107,  i) 
which  surrounds  the  infundibulum.  The  optic  nerve  either  transmits  or 
receives  a  few  fibres  from  this  cineritious  neurine,  and  traveling  back- 
wards, becomes  still  more  flattened  as  it  passes  beneath  (the  brain  being 
supposed  to  be  in  its  natural  position  in  the  skull)  the  crus  cerebri  (fig. 
72,  u),  just  at  the  point  where  that  body  plunges  into  the  hemispheres. 
The  internal  margin  of  the  nerve  is  connected  to  the  crus  cerebri  by 
membrane;  the  external  margin  is  not  so  well  defined  in  consequence 
of  its  giving  some  fibres  to  the  under  part  of  the  middle  lobe  of  the 
cerebrum.  The  tractus  opticus  in  this  curved  portion  of  its  course  lies 
parallel,  and  almost  in  contact,  with  the  inferior  pillar  of  the  fornix,  being 
overlapped,  as  the  student  dissects  from  the  base  of  the  brain,  by  that 
convolution  of  the  middle  lobe  of  the  cerebrum  which  is  called  the  hip- 
pocampus major,  which  it  runs  over  in  the  natural  position  of  the  brain. 
The  tractus  opticus  in  this  part  of  its  course  has  above  it  the  optic  thala- 
mus  (fig.  107,  K).  On  reaching  the  posterior  part  of  the  crus  cerebri, 
the  internal  margin  of  this  band  diminishes,  and  great  care  is  required 
in  tracing  it  to  its  ultimate  cerebral  connections.  The  external  surface 
of  the  optic  nerve  now  becomes  much  widened  ;  some  of  its  filaments, 
viz.,  those  forming  the  internal  margin,  run  inwards  and  become  con- 
nected with  those  little  nodules  of  the  optic  thalami  called  the  corpora 
geniculata  ;  other  fibres  pass  still  further  inwards,  ultimately  terminating 
in  the  tubercula  quadrigemina  (D). 

The  more  superficial  portion  of  the  nerve,  when  traced  backwards,  is 
found  winding  round  the  posterior  extremity  of  the  thalamus  nervi 
optici,  and  spreading  on  the  superior  surface  of  that  ganglion,  becomes 
intimately  connected  with  it.  The  internal  portion  of  this  layer  is 
attached  to  the  peduncles  of  the  pineal  gland.  This  connection  of  the 
optic  nerve  with  the  surface  of  the  posterior  cerebral  ganglion  or  optic 
thalamus  may  be  distinctly  and  easily  demonstrated  on  the  brain  of  the 
sheep,  in  which  animal  the  deeper  portion  is  not  so  large  as  in  man.  I 
have  not  been  able  to  trace  this  superficial  portion  of  the  nerve  into  the 
hemispheres  beyond  the  external  border  of  the  thalamus.  The  remain- 
ing portion  of  the  nerve  continues  its  course  backwards,  and,  spreading 
as  it  runs,  passes  also  a  little  outwards.  It  now  splits  into  two  portions, 
the  division  of  which  cannot,  however,  be  seen  on  the  surface;  for  one 
portion  is  placed  beneath  the  other,  and  plunges  into  the  substance  of  the 
thalamus  (fig.  107,  gg),  where  it  terminates.  I  first  described  these 
fibres  in  a  letter  published  in  the  Medical  Gazette,  vol.  xxi.  They  may 
easily  be  shown  even  in  a  brain  which  has  not  been  hardened  in  alcohol, 


CEREBRAL    NERVES.  235 

by   making  a   section   longitudinally  through  the  tractus   opticus   and 
thalamus  nervorum  opticorura  (fig.  107). 

It  must  be  evident  from  this  description,  that,  notwithstanding  the 
assertion  of  Spurzheim  that u  it  was  a  great  error  to  consider  the  eminences 
called  optic  thalami  as  the  sources  of  the  optic  nerves,"  these  nerves 
are  intimately  connected  with  them.  Nevertheless,  it  is  very  certain  that 
the  optic  thalami  have  a  more  immediate  relation  to  the  hemispheres  of 
the  brain  than  to  the  organs  of  vision.  They  are  always  in  proportion 
to  the  size  of  the  hemispheres,  and,  consequently,  are  found  of  greater 
size  in  man  than  in  any  other  animal. 

S.  W.  Stein,  in  a  thesis  on  the  origin  of  the  optic  nerve,*  considers 
it  as  decided  "  that  the  optic  nerves  are  connected  to  the  thalamus,  and 
that  this  organ  connects  the  optic  nerves  to  the  whole  brain."  Rolando 
denies  that  the  optic  nerves  arise  from,  or  terminate  in,  the  tubercula 
quadrigemina,  asserting  that  they  take  their  origin  from  the  thalamus 
alone. f  This  statement  is  altogether  untenable  with  the  parts  before  us. 

Third  Pair,  or  common  Oculo-muscularJVerve. — The  third  pair  of  nerves, 
the  common  oculo-muscular,  emerges  from  the  cerebral  mass  at  the  inner 
side  of  the  crus  cerebri,  the  medullary  fibres  of  which,  as  already  ex- 
plained, are  continuous  with  the  motory  tract  of  the  spinal  cord.  This 
is  not,  however,  the  real  origin  of  this  nerve ;  for  if  it  be  traced  care- 
fully, it  will  be  found  not  merely  to  be  connected  with  the  surface  of  the 
crus  cerebri,  but  dipping  beneath  it,  and  there  dividing  into  two  por- 
tions :  one  of  these  ascends  through  the  pons  Varolii  to  be  connected 
with  the  motor  tract  in  its  passage  through  that  commissure  ;  the  other 
passes  through  the  locus  niger,  and  splits  in  five  or  six  white  threads, 
which,  separated  by  the  gray  neurine,  present  a  beautiful  appearance  in 
a  fresh  brain  (see  fig.  107,  c).  Mr.  Grainger  first  demonstrated  this 
arrangement  to  me.  These  filaments,  after  traversing  this  deposit  of 
cineritious  matter,  reach  those  fibres  which  the  motor  tract  sends  through 
at  this  point  to  the  inter-cerebral  commissure  or  processus  e  cerebello 
(fig.  102).  From  this  origin  the  third  nerve  passes  forwards  on  the  outer 
side  of  the  posterior  clinoid  process,  and  penetrates  the  dura  mater  mid- 
w7ay  between  the  anterior  and  posterior  clinoid  processes,  where  it  enters 
a  space  left  between  the  under  surface  of  the  dura  mater  and  the  side  of 
the  sella  turcica,  which,  we  have  seen,  constitutes  the  cavernous  sinus. 
It  runs  along  the  upper  part  of  this  sinus,  quitting  the  cavity  of  the 
skull  at  the  foramen  lacerum  orbitale,  and  thus  entering  the  orbit,  within 
which  it  is  distributed  to  the  levator  palpebra,  and  to  the  levator,  ab- 
ductor, and  depressor  oculi.  The  more  particular  distribution  of  these 
nerves  will  be  found  described  in  most  of  the  elementary  anatomical 
works,  to  one  or  other  of  which  I  shall  therefore  refer  my  readers  for 
further  information.^: 

Fourth  Pair,  or  inner  Oculo-muscular. — Theybwr^  pair  of  nerves,  also 
called  the  pathetic,  and  the  smallest  of  the  cerebral  nerves,  emerges  from 
the  surface  of  the  inter-cerebral  commissure,  close  to  the  optic  tubercles. 

*  De  Thalamo  et  origine  nervi  optici,  &c.     Haunise,  1833. 
t  Page  92,  op.  cit. 

*  Let  me  here  particularly  recommend  the   excellent  practical  manual  of  my  friend  and 
colleague  Mr.  F.  Le  Gros  Clark. 


236  HUMAN   BRAIN. 

It  arises  much  deeper  from  the  olivary  portion  of  the  pyramidal  or  motor 
tract  (107,  D).  The  fourth  pair  of  nerves,  at  their  origin,  are  connected 
together  by  a  distinct  commissure,  more  evident  in  some  brains  than  in 
others.  From  this  origin  they  take  their  course,  between  the  cerebrum 
and  cerebellum,  along  the  edge  of  the  tentorium,  by  which  membrane 
they  appear  to  be  conducted  to  the  posterior  clinoid  processes,  where, 
entering  the  cavernous  sinus,  they  take  their  course,  in  the  posterior 
part  of  that  cavity,  just  below  the  third  ;  but  as  they  approach  the  fora- 
men lacerum  orbitale,  they  cross  above  the  third  pair,  and,  on  their 
entrance  into  the  orbit,  are  situated  to  the  inner  side  of  the  third  pair : 
they  supply  the  superior  oblique  muscle  of  the  eye. 

Fifth  Pair,  or  Trigeminal. — The  fifth  or  trigeminal  consists  of  two 
portions,  the  one  for  sensation  and  the  other  for  motion.  The  sensory 
portion  commences  by  numerous  filaments  from  the  surface  of  the  mu- 
cous membrane  of  the  nose,  of  the  palate,  from  the  pulpy  structure  of 
the  teeth  in  both  jaws,  from  the  papillae  of  the  tongue,  from  many  parts 
contained  within  the  orbit,  the  lachrymal  apparatus,  the  conjunctiva, 
&c.,  and  from  the  skin  covering  the  face.  The  numerous  filaments 
from  all  these  sources  are  collected  into  separate  portions,  which  pass 
individually  into  the  skull.  The  first  division  passes  through  the  fora- 
men lacerum  orbitale;  the  second  through  the  foramen  rotundum;  and 
the  third,  through  the  foramen  ovale.  Under  the  dura  mater  in  the 
temporo-sphenoidal  fossa,  they  enter  the  lower  edge  of  the  cineritious 
matter  of  the  semilunar  ganglion  of  the  fifth  nerve.  From  the  concave 
edge  of  the  semilunar  ganglion  other  fibres  arise,  which,  passing  over 
the  anterior  surface  of  the  petrous  portion  of  the  temporal  bone,  pene- 
trate the  dura  mater  on  the  outer  side,  and  below  the  posterior  clinoid 
processes.  They  then  run  direct  to  the  upper  edge  of  the  pons  Varolii, 
and,  passing  between  the  fibres  of  this  commissure,  descend  completely 
through  its  substance,  maintaining  their  individuality  down  through  the 
medulla  oblongata,  till  they  terminate  in  the  posterior  portion  of  the 
antero-lateral  columns  of  the  spinal  cord,  about  an  inch  and  a  half  be- 
low the  pons  Varolii,  as  represented  in  fig.  107,  e\  and  fig.  108. 

This  termination  of  the  sensory  root  of  the  fifth  is  so  close  to  that  of 
the  motor  division,  that  Dr.  Alcock  considers  that  they  arise  from  the 
same  tract.  This  is  not  the  case,  as  the  olivary  tract  to  which  the 
motor  root  is  attached,  is  on  the  outer  side  of  the  sensory  tract,  and  dis- 
tinct from  it  (see  figs.  94,  107). 

The  motory  portion  of  the  fifth  nerve,  again,  does  not  arise,  as  usually 
described,  from  the  continuation  of  the  anterior  columns  or  motory  tract 
while  passing  through  the  pons  Varolii  or  commissure  of  the  cerebel- 
lum, but  passing  beneath  the  inter-cerebral  commissure,  very  close  to 
the  cerebellum,  as  designated  in  fig.  107,  runs  from  this  point  down- 
wards to  the  olivary  portion  of  the  motor  tract,  as  it  ascends  to  the  optic 
tubercles.  This  root  of  the  fifth  pair  of  nerves  is  described  by  Dr.  Al- 
cock, in  his  admirable  article  "  on  the  Fifth  Pair  of  Nerves,"  in  the 
Encyclopaedia  of  Anatomy,  parts  xi.  and  xii.,  as  arising  from  the  anterior 
columns  of  the  spinal  cord,  where  they  form  part  of  the  medulla  oblon- 
gata. I  have  not  yet  succeeded  in  tracing  it  so  low  down  as  that  point. 
The  motor  root  emerges  from  the  pons  Varolii,  almost  close  to  the  spot 


CEREBRAL   NERVES.  237 

where  the  sensory  division  enters  it,  after  which  it  is  applied  to  the  sen- 
sory portion  of  the  nerve.  As  it  then  passes  through  the  same  foramen 
in  the  dura  mater,  and  enters  the  temporo-sphenoida!  fossa,  it  slides 
behind  the  semilunar  ganglion,  to  which  it  is  connected  by  membrane, 
but  not  by  neurine.  It  quits  the  skull  at  the  foramen  ovale,  and  is  then 
distributed  to  the  muscles  concerned  in  the  motions  of  mastication,  viz., 
the  masseter,  temporal,  pterygoid,  and  buccinator. 

To  recapitulate :  the  motory  portion  of  the  fifth  nerve  emerges  from 
between  the  fibres  of  the  pons  Varolii,  very  close  to  the  spot  where  the 
sensory  portion  enters:  but  in  all  cases  in  which  I  have  dissected  it, 
the  motory  is  separated  from  the  sensory  portion  by  a  bundle  of  fibres 
of  the  pons  Varolii,  of  variable  thickness.  If  the  nerve  be  traced  with 
great  care — which  is  necessary,  for  it  is  very  thin  and  easily  torn — it 
will  be  found  running  backwards  and  upwards,  towards  the  inter-cere- 
bral commissure  or  processus  e  cerebello  ad  testes,  behind  the  fibres  of 
which  it  descends,  until  it  reaches  the  medulla  oblongata. 

Sixth  Pair,  or  .ftbducentes. — The  sixth  pair  arises  from  the  motor  tract, 
at  the  inferior  edge  of  the  commissure  of  the  cerebellum,  just  as  it  is 
about  to  pass  through  that  structure,  proceeding  immediately  from  the 
portion  of  the  anterior  columns  known  as  the  pyramidal  bodies  ;  the 
nerve  directs  its  course  forward  towards  the  upper  edge  of  the  basilary 
process  of  the  os  occipitis,  at  which  point,  or  at  the  distance  of  about 
half  an  inch  below  the  posterior  clinoid  processes,  it  penetrates  the  dura 
mater.  It  then  advances  upwards,  and,  crossing  the  superior  angle  of 
the  petrous  portion  of  the  temporal  bone,  it  enters  the  cavernous  sinus, 
where  it  crosses  the  carotid  artery  at  nearly  a  right  angle,  being  joined 
at  the  anterior  edge  of  the  vessel  by  some  filaments  from  the  sympa- 
thetic nerve  or  cyclo-gangliated  system,  which  accompany  the  sixth 
nerve  into  the  orbit,  and  are  connected  with  the  lenticular  ganglion. 

The  sixth  nerve,  in  its  course  through  the  cavernous  sinus,  is  situated 
the  most  internally ;  but  under  the  transverse  spinous  process  of  the 
sphenoid  bone,  and  just  previous  to  its  passage  through  the  foramen 
lacerum  orbitale,  it  is  crossed  by  the  ophthalmic  division  of  the  fifth 
pair  in  its  course  from  the  orbit  to  the  semilunar  ganglion.  The  sixth 
nerve  is  finally  distributed  to  the  abductor  muscle  of  the  eye.  This 
nerve,  let  it  be  remembered,  in  a  physiological  point  of  view,  is  merely 
a  portion  of  the  third,  its  separation  from  which  by  the  pons  Varolii  is 
perfectly  analogous  to  the  separation  of  the  roots  of  the  spinal  nerves  by 
a  blood-vessel  running  between  them,  and  of  no  greater  physiological 
importance. 

Seventh  Pair,  Facial,  or  Portio  Dura. — The  facial  nerve,  which  emerges 
from  the  groove  between  the  corpus  pyramidale  and  olivary,  just  below 
the  pons  Varolii,  may  be  traced  backwards  through  the  substance  of  that 
commissure  in  which  it  runs  immediately  to  the  inner  side  of,  and  in 
contact  with,  the  sensory  root  of  the  fifth  pair  of  nerves  (see  fig.  108). 
On  arriving  even  with  the  posterior  and  superior  surface  of  this  portion 
of  the  fifth  pair  of  nerves,  the  seventh  appears  to  split  into  two  parts, 
the  one  running  inwards  to  be  connected  with  the  olivary  portion  of  the 
motor  tract  of  the  spinal  cord  in  its  passage  through  the  pons  Varolii, 
the  other  division  proceeding  outwards  to  be  connected  with  that  por- 


238  HUMAN    BRAIN. 

tion  of  the  corpus  restiforme  which  I  have  described  as  being  derived 
from  the  motor  tract  of  the  cord  (see  figs.  89  and  90). 

From  this  origin  the  seventh  nerve  passes  forward  to  the  foramen 
auditivum  internum,  passing  through  which,  and  entering  the  stylo- 
raastoid  canal,  it  quits  the  skull  at  the  inferior  orifice  of  this  canal,  where, 
becoming  external,  it  is  finally  distributed  to  several  of  the  muscles 
taking  their  rise  from  the  styloid  process  of  the  temporal  bone,  to  the 
platysma  myoides,  and  to  all  the  muscles  of  the  face. 

Eighth  Pair,  Auditory,  or  Portio  Mollis. — The  eighth  or  auditory  nerve 
commences  from  the  pulp  which  lines  the  labyrinth  of  the  ear.  Its 
fibres  gradually  unite  so  as  to  form  a  single  cord,  which  quits  the  tempo- 
ral bone  at  the  foramen  auditivum  internum,  and  directs  its  course  to  the 
posterior  part  of  the  medulla  oblongata,  being  connected  to  the  facial 
nerve  by  cellular  membrane.  On  reaching  the  medulla  oblongata  oppo- 
site the  inferior  edge  of  the  pons  Varolii,  where  the  facial  nerve  emerges, 
the  auditory  splits  into  two  portions  (fig.  108).  One  of  these  passes 
through  the  substance  of  the  medulla  oblongata  anterior  to  the  corpus 
restiforme,  and  plunges  into  its  appropriate  ganglion,*  the  posterior  pyra- 

Fig.  108. 


This  figure  exhibits  the  origin  of  the  facial,  not  as  it  is  usually  described,  but  as  I  found  it  on  three  pre- 
parations which  I  dissected  in  succession.  The  origin  of  the  auditory,  split  by  the  restiform  body  (w)  by 
two  roots,  the  inner  from  the  olivary  tract  as  it  passes  through  the  pons,  the  other  from  those  fibres  of  the 
anterior  columns  which  cover  the  corpus  restiforme  (w),  as  shown  in  this  figure,  has  been  known  for 
some  time  to  a  few  anatomists,  but  is  not  usually  described  so  in  most  systematic  writers. 

*  Foville  gives  the  following  strange  doctrine,  as  it  appears  to  me  (p.  507,  op  cit.)  : — "  The 
enlargement  known  under  the  name  of  the  Gasserian  ganglion,  and  assimilated  to  the  true 
spinal  ganglia  of  the  posterior  roots  of  the  nerves,  seems  to  us  to  differ  essentially  from 
them,  and  that  the  ruban  gris,  or  the  gray  matter  on  the  posterior  fasciculus,  and  united  to 
the  auditory  nerve,  might  quite  as  legitimately  be  assimilated,  to  a  spinal  ganglion.  We 
consider  the  ruban  gris  as  a  part  of  the  gray  substance  of  the  posterior  fasciculus  spread 
upon  the  surface  of  the  cerebellar  ventricle,  and  concurring  to  form  the  roots  of  the  auditory 
nerve.  The  true  ganglia  of  the  auditory  and  trigeminal  are  to  us  the  cerebellar  hemispheres 
and  the  vermiform  eminences." 


CEREBRAL   NERVES.  239 

midal  body  (fig.  78).  The  other,  which  is  the  posterior  division  of  the 
nerve,  winds  round  the  restiform  body,  which  is  thus  hid  between  the 
two  portions  of  the  nerve  as  in  a  fossa,  and  then  crossing  the  posterior 
fissure  of  the  cord  or  fourth  rentricle,  forms  by  its  separation  three  or 
four  white  lines,  which  are  usually  rery  distinct  (fig.  78).  Meckel* 
states  that  he  has  sometimes  found  the  whole  of  these  lines  deficient, 
sometimes  on  one  side  and  sometimes  on  both,  and  that  Prochaska  and 
Wenzel  have  observed  them  to  differ  on  the  two  sides  of  the  brain. 
Meckel  views  these  striaB  as  not  merely  the  roots  of  the  auditory  nerve, 
but  as  connected  both  with  the  trigeminal  and  pneumogastric  nerves. 

Ninth  Pair,  or  Glosso-pharyngeal  Nerve. — The  ninth  pair,  called  also 
the  glosso-pharyngeal  nerve,  arises  from  the  pneumogastric  or  restiform 
ganglion  and  cerebellic  fibres  of  the  anterior  columns,  immediately  above 
the  pneumogastric  nerve,  by  one  or  two  roots  (fig.  107,  i).  It  runs  for- 
wards to  the  foramen  lacerum  posterius,  passing  through  which  it  quits 
the  skull,  separated  from  the  jugular  vein  by  a  process  of  dura  mater 
and  a  spiculum  of  bone;  arid  passing  down  the  stylo-pharyngeal  muscle, 
is  finally  distributed  to  the  muscles  of  the  pharynx  and  tongue. 

Tenth  Pair,  or  Pneumogastric. — The  tenth  pair,  the  pneumogastric 
nerve  or  par  vagum,  is  a  compound  nerve,  like  most  of  the  spinal  nerves ; 
that  is  to  say,  it  consists  of  two  tracts  of  neurine  bound  up  together,  the 
one  for  sensation,  the  other  for  motion.  The  motor  filaments  of  the 
nerve  are  not  entirely  conductors  of  volition,  for  most  of  the  muscular 
fibres  that  are  brought  into  action  by  this  nerve  are  independent  of  the 
will;  the  only  exception  being  the  muscles  of  the  larynx  concerned  in 
the  production  of  vocal  sounds:  and  as  one  portion  of  the  tract  of  volition 
runs  close  upon  the  posterior  edge  of  the  corpus  olivare,  from  which 
these  filaments  probably  arise,  we  have  no  difficulty  in  reconciling  the 
fact  of  one  portion  of  the  nerve  being  destined  for  voluntary  and  the 
remainder  for  involuntary  motion  and  sensation,  as  the  constitution  of 
this  nerve  is  proved  to  be  by  the  most  accurate  experiments  and  observa- 
tions. This  nerve  has  two  origins  or  central  attachments,  one  to  the 
cerebellic  fibres  of  the  anterior  columns  as  they  form  part  of  the  resti- 
form body;  the  other  may  be  traced  through  the  fibres  of  the  restiform 
body  into  some  gray  matter  at  the  posterior  surface  of  the  cord,  the  resti- 
form ganglion  (fig.  107).  This  deposit  of  cineritious  neurine  is  both 
physiologically  and  anatomically  distinct  from  that  in  which  the  auditory 
nerve  terminates,  as  I  have  shown  by  repeated  dissections  of  this  part 
in  the  human  subject,  and  in  the  calf,  horse,  and  other  animals,  as  before 
stated  in  the  section  on  comparative  anatomy  (see  figs.  52 — 56).  Stil- 
ling describes  this  gray  matter  as  the  ganglion  of  the  pneumogastric 
nerve.  Accompanying  these  nerves  in  their  passage  from  the  skull  is  a 
spinal  nerve,  which,  instead  of  quitting  the  vertebral  canal  like  the 
spinal  nerves  in  general,  enters  the  cavity  of  the  skull  by  the  foramen 
magnum,  and  adding  itself,  as  it  were,  to  the  glosso-pharyngeal  and 
pneuraogastric,  is  from  this  circumstance  called  the  ppinal  accessory.^ 

*  Anatomie,  tome  ii.  p.  614,  n. 

f  "In  the  medulla  oblongata,"  says  Forille  (p.  500),  the  nerves  of  the  posterior  fasciculus 
are  grouped  into  two  distinct  cords  of  great  importance — the  pneumogastric  and  glosso- 
pharyngeal."  His  description  of  their  origin  is  most  meagre  and  unsatisfactory.  He  states 


240  HUMAN    BRAIN. 

Eleventh  Pair,  or  Lingual  Nerve.  —  The  last  of  the  cerebral  nerves  is  the 
lingual,  or  the  eleventh  pair.  This  nerve  arises  in  a  groove  between  that 
portion  of  the  anterior  columns  of  the  medulla  oblongata  usually  desig- 
nated the  pyramidal  bodies,  and  the  corpora  olivaria.  I  believe  that  its 
origin,  like  all  the  spinal  nerves,  is  double,  one  set  of  fibres  being  con- 
nected with  the  brain  through  anterior  columns  of  the  cord,  and  the  other 
with  the  gray  matter  ;  the  olivary  body  being  to  this  nerve  what  the 
anterior  peaks  of  gray  matter  are  to  the  other  spinal  nerves.  Mayo 
states*  that  some  of  the  "fasciculi  of  the  lingual  nerve  penetrate  to  the 
gray  capsule  in  the  olivary  body."  It  commences  by  several  filaments, 
which  being  collected  together,  the  nerve  they  compose  quits  the  skull 
at  the  foramen  condyloideum  anterius.  It  is  distributed  to  the  muscles 
of  the  tongue  and  also  to  those  of  the  os  hyoides,  viz.,  the  omohyoideus 
and  sterno-hyoideus,  which  fix  the  bone  inferiorly. 

Regarding  the  origin  of  this  nerve,  Foville  states  really  nothing. 
He  saysf  it  is  detached  from  the  medulla  oblongata  between  the  corpus 
pyramidale  and  olivary  body,  but  not  one  word  regarding  its  connection 
with  the  interior  of  the  medulla.  StillingJ  traces  it  to  the  posterior  sur- 
face of  the  cord  into  what  I  have  described  as  the  auditory  ganglion  ; 
but  I  think  he  is  mistaken. 

that  the  arciform  fibres  of  Rolando  unite  with  the  pneumogastric  and  glosso-pharyngeal 
nerves,  and  then  goes  on  to  say,  "  There  are  certainly  some  difficulties  which  have  not  yet 
been  resolved  in  a  satisfactory  manner  relative  to  the  roots  of  the  pneumogastric  and  glosso- 
pharyngeal  nerves." 

*  Plates  of  the  Brain,  VII.  fig.  2.  f  P-  527« 

J  P.  21,  op.  cit. 


rf) 


241 


PART   VIII. 

• 

VESSELS  EMPLOYED  IN  THE  CEREBRAL  CIRCULATION. 

As  the  brain  receives  one-fifth  of  the  whole  amount  of  blood  circu- 
lating in  the  body,  the  student  will  not  be  surprised  to  find  it  supplied 
with  this  fluid  by  four  large  arteries,  the  internal  carotids  and  the  verte- 
brals. 

The  internal  carotid  arteries  are  derived  from  the  common  carotids 
opposite  the  os  hyoides:  ascending  from  their  point  of  origin,  they  reach 
the  base  of  the  skull,  and  enter  its  cavity  by  the  foramen  caroticum  and 
carotid  canal.  The  course  of  the  vessel  in  this  canal  is  worthy  of  ob- 
servation. Changing  the  nearly  vertical  course  they  held  at  the  external 
orifice  for  one  almost  horizontal  in  its  direction,  they  advance  forwards 
and  inwards  through  the  space  of  about  an  inch  ;  they  then  form  a  curve, 
resume  their  nearly  vertical  course,  and  quit  the  carotid  canal  by  the 
foramen  caroticum  internum.  At  this  point  the  vessels  bend  forwards 
horizontally  again,  passing  through  the  cavernous  sinuses,  groove  the 
outer  surface  of  the  sella  turcica,  and  at  the  inner  side  of  the  anterior 
clinoid  processes,  they  pierce  the  dura  mater  and  enter  the  proper  cere- 
bral cavity.  It  is  impossible  to  follow  the  two  carotid  arteries  in  this 
way  without  the  peculiarity  of  their  course  forcing  itself  upon  the  atten- 
tion. The  changes  from  a  perpendicular  to  a  horizontal  direction  cannot 
have  been  ordained  without  some  peculiar  purpose  to  be  fulfilled,  and 
the  end  most  probably  has  been  to  protect  the  delicate  structure  of  the 
brain  from  any  ill  effects  which  the  suddenly  increased  or  hurried  action 
of  the  heart  would  have  been  liable  to  produce  had  the  tube  been  per- 
fectly straight  and  the  wave  of  circulating  fluid  been  suffered  to  arrive 
directly,  and  with  its  force  unbroken,  within  the  cavity  of  the  skull. 

This  view  of  the  subject  is  corroborated  by  the  existence  of  that  com- 
plicated plexus  of  vessels,  called  the  rete  mirabile,  emanating  from  the 
internal  carotid  artery,  and  situated  at  the  base  of  the  brain.  This  beau- 
tiful arrangement  of  the  carotid  arteries  is  to  be  remembered  in  connec- 
tion with  the  protective  apparatus  of  the  brain. 

The  branches  of  the  internal  carotid  artery,  as  regards  the  brain,  are 
three  in  number;  two  supplying  the  brain  immediately,  and  one  simply 
forming  a  communication  or  anastomosis  with  the  branches  of  the  verte- 
bral artery.  The  two  first  are  the  anterior  and  middle  cerebral  arteries. 

The  student  will  meet  with  very  accurate  delineations  of  these  arteries 
in  Professor  Richard  Quain's  folio  work  on  this  subject ;  the  most  valu- 
able work  which  for  years  has  issued  from  the  press  of  this  country, 
i  ?«  >x«Mtimfc  t*  «•  ^m  tomi^t  v  ,-»*>->*i».-. 


242  HUMAN    BRAIN. 

estimated  either  for  the  practical  importance  of  its  facts,  or  for  its  beauty 
as  a  work  of  art. 

The  anterior  first  runs  inwards  towards  the  great  median  fissure,  where 
approaching  very  close  to  its  fellow  on  the  opposite  side,  the  two  are 
united  by  a  short  transverse  branch,  called  the  transverse  artery  of  the 
cerebrum.  The  anterior  cerebral  artery  continues  its  course  in  the  an- 
terior part  of  the  median  fissure  between  the  two  lateral  hemispheres, 
giving  off  numerous  branches  in  its  course,  winding  round  the  great 
transverse  commissure,  and  running  backwards  on  its  upper  surface, 
where  it  receives  the  name  of  artery  of  the  corpus  callosum. 

The  middle  cerebral  runs  deeply  within  the  fissura  Sylvii,  through  which 
it  continues  its  course,  arid  ultimately  reaches  the  upper  surface  of  the 
hemispheres. 

The  third  branch  of  the  carotid,  called  the  communicating  artery,  is 
small  but  interesting  ;  for  running  backwards,  and  joining  with  the  pos- 
terior artery  of  the  cerebrum,  a  branch  of  the  basilary  artery  to  be  de- 
scribed further  on,  it  connects  these  large  arterial  channels  together,  and 
lessens  the  danger  of  accident  to  the  brain  from  obstruction  to  the  cir- 
culation in  one  channel,  and  from  an  irregular  supply  of  the  vital  fluid. 
When  tracing  the  connection  of  the  two  communicating  arteries  with 
the  basilary  branches,  a  perfect  arterial  circle  will  be  observed  to  be 
formed,  the  sides  being  constituted  by  the  communicating  artery,  the 
posterior  part  by  the  basilary,  the  front  by  the  anterior  arteries  of  the 
cerebrum  and  the  transverse  artery.  This  curious  circle  is  celebrated 
under  the  title  of  the  circle  of  Willis,  who  first  described  it.  This  free 
anastomosis  is  of  the  greatest  importance  to  such  an  organ  as  the  brain, 
for  if  by  any  accidental  circumstance  the  flow  of  blood  is  arrested  in 
one  channel,  there  is  another  immediately  ready  for  it. 

The  vertebral  arteries  arise  from  the  subclavian  at  the  lower  part  of 
the  neck,  immediately  anterior  to  the  passage  of  that  artery  between  the 
scaleni  muscles. 

The  vertebral  has  a  long  course  from  this  point  to  the  cavity  of  the 
skull,  and  nature  has  beautifully  provided  for  its  protection  by  sending 
it  through  a  bony  and  ligaraentous  canal,  bored,  as  it  were,  for  it  in  the 
transverse  processes  of  the  cervical  vertebrae.  This  vessd,  though  much 
smaller  than  the  internal  carotid  artery,  does  not  run  in  a  direct  course 
from  the  heart  to  the  skull,  nor  begin  to  distribute  its  blood  to  the  brain, 
till  it  has  undergone  a  succession  of  curves  by  which  the  impetus  of  the 
contained  blood  must  be  materially  diminished.  On  quitting  the  fora- 
men in  the  transverse  process  oif  the  first  cervical  vertebra,  the  artery 
courses  round  the  articulating  process  of  that  bone,  and,  like  the  carotid, 
taking  a  horizontal  direction,  it  enters  the  skull  through  the  foramen 
magnum.  Within  the  cranial  cavity  the  two  vertebral  arteries  approach 
each  other,  and  on  the  basilary  process  of  the  occipital  bone,  they  inos- 
culate at  an  acute  angle  and  form  a  single  trunk.  The  single  artery  thus 
produced  is  designated  from  its  relation  to  the  occipital  bone,  the  basilary 
artery. 

The  branches  of  the  vertebral  are  three  in  number;  two  to  the  spinal 
cord  and  one  to  the  cerebellum.  The  two  arteries  to  the  cord  called  the 
anterior  and  posterior  spinal  arteries^  though  of  small  size  at  their  origin, 


CEREBRAL   CIRCULATION.  243 

run  the  whole  length  of  the  vertebral  canal  to  the  os  coccygis,  giving 
off  numerous  branches  in  their  course.  Their  calibre,  however,  is  almost 
undiminished  even  to  their  termination,  in  consequence  of  their  being 
reinforced  by  frequent  anastomoses  with  the  branches  of  the  deep  cervi- 
cal, intercostal,  and  lumbar  in  particular. 

The  branch  to  the  cerebellum  is  called  the  inferior  artery  of  the  cere- 
bellum, and  supplies,  as  its  name  indicates,  the  under  surface  of  that 
portion  of  the  brain. 

The  branches  of  the  basilary  artery  are  three  in  number  on  each  side. 
One  of  these  is  not,  however,  distributed  to  the  brain,  but  to  the  inter- 
nal ear.  Of  the  other  two,  one  supplies  the  cerebellum,  called,  in  dis- 
tinction to  the  last  mentioned  cerebellic  artery,  the  superior  artery  of  the 
cerebellum;  the  other  is  distributed  to  the  cerebrum  supplying  the  pos- 
terior surface  of  the  hemisphere,  and  is  called  the  posterior  artery  of  the 
cerebrum. 

In  relation  to  cerebral  circulation  we  must  refer  to  the  thyroid  gland ; 
for  there  is  now  but  little  doubt  that  this  sanguineous  gland  acts  as  a 
diverticulum  to  the  brain.  I  have  long  thought  so,  and  for  years  was  in 
the  habit  of  mentioning  to  my  class  the  facts  which  supported  such  an 
hypothesis.  The  recent  accurate  and  extended  researches  of  Mr.  Si- 
mon,* have,  I  think,  fully  established  this  view  of  its  office.  The  fol- 
lowing are  Mr.  Simon's  conclusions. 

1.  The  thyroid  gland,  or  an  organ  representing  its  place  and  office, 
may  be  found  in  all  vertebrate  animals. 

2.  It  does  not  appear  (as  is  the  case  with  some  organs)  to  belong  to 
these  animals  merely  in  behoof  of  the.great  general  completeness  of  their 
organization,  but  seems  to  have  a  particular  reference  to  that  specific 
character  which   binds  them  together  as  a  natural  section  of  the  animal 
kingdom — namely,  the   aggregation  and  more  perfect  development  of 
their  nervous  centres  ;  for 

3.  The  gland,  shifting  its  position  most  variously,  yet  always  main- 
tains an  intimate  relation  to  the  vascular  supply  of  the  brain,  always  is  so 
nourished  that  it  can  alternate  a  greater  or  lessnutrition,  according  to  the 
activity  or  repose  of  that  nervous  centre. 

4.  The  organ  which  in  certain  fishes  represents  a  rudimental  form  of 
the  thyroid,  is  plainly  a  mere  diverticulum  to  the  cerebral  circulation  ;  in 
the  remaining  fishes  (where  a  more  perfect  thyroid  exists),  as  likewise 
in  the  ascending  scale  of  vertebrate  animals,  there  is  no  essential  change 
from  the   vascular  organization  of  the   branchiola — there  is  simply  the 
superaddition  of  a  glandular  structure.     The  thyroid  is  but  a  higher  de- 
velopment of  the  branohiola.     What  was  a  mere  capillary  plexus  now 
has  gland-cells  intermingled  with  its  texture. 

Probably,  then,  the  use  of  the  secretory  actions  occurring  in  the  thy- 
roid gland  is  to  be  found  in  harmony  with  the  obvious  intention  of  its 
vascular  supply;  as  the  latter  is  diverticular,  so  we  may  expect  the 
former  to  be  vicarious  or  alternative. 

*  Phil.  Trans.,  Part  II,  1844. 


244 


PAST  IX. 

DEVELOPMENT  OF  THE  BRAIN. 

THE  development  of  the  human  brain  is  a  subject  which  every  philo- 
sophical inquirer  into  the  laws  of  organization  will  find  invested  with 
peculiar  interest.  The  vast  mass  of  facts  which  have  been  accumulated 
for  its  elucidation  are  amongst  the  most  satisfactory  and  conclusive  in 
proof  of  the  existence  of  general  laws  instituted  by  an  Almighty  power, 
and  in  conformity  with  which  every  organ  in  the  animal  series  is  found 
to  be  framed  on  one  beautifully  simple  and  harmonious  plan  ;  and  as  it 
is  only  by  the  discovery  of  the  general  laws  which  regulate  the  pheno- 
mena of  vitality  that  we  can  ever  expect  to  raise  the  study  of  physiology 
to  hs  legitimate  rank  among  the  natural  sciences,  we  ought  to  recognize 
with  especial  gratitude  the  well-digested  store  of  interesting  facts  con- 
tained in  the  works  of  Tiedemann,  Serres,  the  Wenzels,  and  Doellinger, 
on  the  evolution  of  the  brain.  Newton,  whose  vast  discoveries  in  ano- 
ther of  the  realms  of  nature  have  raised  him  so  far  above  his  fellow 
mortals  that  we  almost  reverence  his  name,  showed  us  that  true  philo- 
sophy simply  consists  in  the  discovery  of  the  universality  of  a  fact. 
How  abundant,  since  Newton's  day,  has  been  the  harvest,  to  those  whose 
researches  have  been  guided  by  this  simple  principle,  to  which  alone 
we  are  indebted  for  any  knowledge  we  possess  of  the  laws  by  which 
the  Creator  governs  the  universe;  for" we  perceive,  as  Dr.  Paley  finely 
expresses  it,  that  u  God  has  been  pleased  to  prescribe  limits  to  his  own 
power,  and  to  work  his  ends  within  those  limits.  The  general  laws  of 
matter  have,  perhaps,  the  nature  of  these  limits:  its  inertia,  its  reaction, 
the  laws  which  govern  the  communication  of  motion,  of  light,  of  heat, 
of  magnetism,  electricity,  and  probably  of  others  yet  undiscovered. 
These  are  general  laws,  and  when  a  particular  purpose  is  to  be  effected, 
it  is  not  by  making  them  wind  and  bend  and  yield  to  the  occasion,  (for 
Nature  with  great  steadiness  adheres  to  and  supports  them,)  but  it  is,  as 
we  observe  in  the  structure  of  the  eye,  by  the  interposition  of  an  appa- 
ratus corresponding  with  those  laws,  and  suited  to  the  inquiry  which 
results  from  them,  that  the  purpose  is  at  length  effected."* 

This  simple  view  of  the  existence  of  fixed  laws,  established  by  the 
Almighty,  is  not,  however,  confined  to  mere  matter  and  its  properties ; 
the  scientific  physiologist  has  reason  to  believe  that  there  are  similar 
laws  which  regulate  vital  phenomena,  and  produce  results,  without  the 
constant  and  immediate  agency  of  the  Supreme  Being. 

*  Natural  Theology,  chap.  iii. 


DEVELOPMENT.  245 

It  is  told  of  Newton,  that  one  day  \vhen  meditating  on  the  simplicity 
and  harmony  of  the  laws  which  regulate  the  universe,  and  struck  par- 
ticularly with  the  relations  and  uniformity  of  the  masses  of  the  planetary 
system,  his  thoughts  reverting  thence  to  the  animal  kingdom,  whose 
wonderful  organization  attests  in  no  less  degree  the  supreme  wisdom, 
and  power  of  a  creating  Providence,  he  exclaimed,  "I  doubt  not  that 
animals  are  subjected  to  the  same  uniformity."  The  only  true  philoso- 
phical plan  upon  which  any  branch  of  physiology  can  be  studied,  is  to 
follow  out  this  idea  of  Newton,  and  strive  to  discover  such  an  harmo- 
nious arrangement  among  its  objects;  for  example,  to  attain  a  knowledge 
of  the  great  principle  which  is  in  operation  during  the  life,  or  which 
presides  over  and  regulates  the  development  of  the  individual  beings 
composing  the  animal  kingdom.  And  here  we  must  carefully  guard 
against  being  seduced  by  the  vain  attempt  to  gain  a  knowledge  of  the 
ultimate  cause  of  vital  phenomena;  we  must  strictly  content  ourselves 
with  observing  those  phenomena  so  as  to  ascertain  their  relations,  their 
harmony  one  to  another,  and  their  effects.  It  is,  indeed,  only  by  study- 
ing physiology  on  these  principles  that  it  can  ever  truly  deserve  the 
name  of  a  science,  or  afford  us  that  clear  and  steady  light  which  will 
guide  us  philosophically  amid  the  intricate  paths  of  pathology  and  the- 
rapeutics. 

Physiologists  in  general  have  too  much  neglected  to  conduct  their 
studies  in  accordance  with  this  idea  of  Newton  ;  they  have  too  constantly 
amused  themselves  with  creating  theories  on  one  or  two  isolated  facts, 
or  in  vainly  searching  after  the  ultimate  cause  of  vital  phenomena :  it  is 
but  of  late  that  they  have  begun  to  content  themselves  with  observing 
their  uniform  relations  and  with  scrutinizing  their  effects,  and  that  they 
have  ceased  from  being  the  laughing-stocks  of  true  philosophy. 

If,  indeed,  we  required  proof  of  the  present  imperfect  state  of  physi- 
ology, and  the  mean  rank  which  it  holds  in  comparison  with  the  other 
branches  of  natural  philosophy,  we  have  only  to  refer  to  cotemporary 
writers,  where  we  still  find  such  passages  as  the  following,  in  which  the 
writer,  after  stating  how  ignorant  we  are  of  the  nature  of  the  intellectual 
faculties  in  man,  goes  on  to  say:  "Nay,  the  springs  and  wheelworks  of 
animal  and  vegetable  vitality  are  concealed  from  our  view  by  an  im- 
penetrable veil,  and  the  pride  of  philosophy  is  humbled  by  the  specta- 
cle of  the  physiologist  bending  in  fruitless,  ardor  over  the  dissection  of 
the  human  brain,  and  peering  in  equally  unproductive  inquiry  over  the 
gambols  of  an  animalcule."  Surely  we  ought,  after  this,  to  see  how 
absolutely  necessary  it  has  become  to  cast  aside  crude  and  ill-digested 
hypotheses,  and  to  study  physiology  under  the  guidance  of  the  general 
laws  of  nature  deduced  from  an  unprejudiced  observation  of  fact  and 
circumstance.  Such  a  sweeping  assertion  of  the  fruitlessness  of  the 
labors  of  the  physiologist  as  we  have  above,  is  by  no  means  applicable 
to  the  nature  of  his  studies,  though  it  is  to  the  mode  in  which  they  have 
usually  been  conducted  ;  for  the  physiologist  is  just  as  competent  to  in- 
quire into  the  causes  of  vital  phenomena,  as  the  natural  philosopher  is  into 
those  of  physical  phenomena:  neither  the  one  nor  the  other  can  ever 
ascertain  the  ultimate  cause  of  anything.  All  that  can  be  done  in  either 
natural  philosophy  or  physiology  is  to  study  the  mutual  relations  in  which 


246  HUMAN    BRAIN. 

phenomena  stand  to  one  another,  and  thus  to  trace  their  connection  and 
possible  dependence. 

The  mature  human  frame,  which,  in  its  perfect  adaptation  to  fulfil  the 
ends  of  its  existence,  strikes  the  philosophical  anatomist  with  admiration, 
does  not  result  from  the  gradual  increase  of  an  exact  though  minute 
representation  of  its  perfect  form;  but  during  the  course  of  its  develop- 
ment, and  while  gradually  progressing  towards  its  ultimate  perfection, 
its  constitution  temporarily  assumes  many  forms  which  are  permanently 
retained  by  one  or  other  of  the  members  among  the  lower  orders  of 
creation. 

The  facts  which  prove  the  existence  of  this  law  of  progressive  deve- 
lopment are  derived  from  observation  of  the  different  organs  at  different 
periods  of  the  foetal  existence  ;  and  in  no  set  of  organs  is  its  truth  more 
clearly  shown  than  in  the  various  component  parts  of  the  nervous  sys- 
tem, as  the  reader  will  discover  by  giving  his  attention  to  the  observa- 
tions on  its  development  which  follow.  The  same  thing  may  also  be 
said  in  regard  to  the  law  which  governs  the  development  of  the  vascu- 
lar system  ;  and  as  the  circumstances  are  here  peculiarly  interesting,  and 
may  be  made  introductory  to  those  of  the  subject  we  have  especially  in 
hand,  I  shall  make  no  apology  for  presenting  a  few  of  them  in  this 
place. 

For  instance,  the  first  appearance  of  the  heart  in  the  human  embryo  is 
that  of  a  mere  pulsating  vessel  without  any  division  into  cavities,  or 
thickening  of  its  walls;  an  arrangement  which  in  all  its  simplicity  is 
met  with  as  the  sufficient  instrument  for  effecting  the  circulation  in  (he 
perfect  insect. 

The  next  step  consists  in  the  gradual  dilatation  of  this  tube  into  a  sac, 
previously  to  its  division  into  four  cavities:  and  this  corresponds  with 
the  single  heart  of  the  fish,  consisting  merely  of  an  auricle  for  the  recep- 
tion of  the  blood,  and  a  ventricle  for  its  propulsion. 

As  the  development  advances,  a  second  ventricle  is  added  to  the  first 
on  the  right  side  of  it,  separated  from  the  left  by  a  septum,  which  is  so 
imperfect  that  the  aorta  communicates  with  both  cavities;  and  the  very 
same  arrangement  is  found  to  exist  in  the  adult  crocodile. 

While  the  septum  is  being  formed  in  the  interior,  a  notch  appears  on 
the  exterior,  which,  extending  from  the  apex  to  the  base,  divides  the 
heart  in  exactly  the  same  manner  as  it  is  met  with  in  the  dugong. 

In  the  respiratory  system,  again,  we  find  some  most  extraordinary 
changes  ;  those  we  have  remarked  in  the  vascular  we  could  explain  on 
the  supposition  that  they  were  the  necessary  and  unavoidable  steps  to- 
wards perfection  ;  but  when  we  find  the  human  embryo  assuming  forms 
which  are  afterwards  entirely  discarded,  we  can  only  account  for  it  on 
the  supposition  that  one  general  law  governs  the  developments  of  the 
whole  animal  creation.  The  lungs  in  the  first  instance  are  placed  on 
each  side  of  the  vertebral  column,  like  the  air-bladders  of  fishes,  without 
any  appearance  of  trachea  or  branchial  tubes;  an  arrangement  which, 
though  interesting,  as  being  analogous  to  the  permanent  state  in  fishes, 
has  nothing  peculiarly  extraordinary  in  it;  but  finding,  in  addition  to 
this,  and  in  perfect  correspondence  with  it,  branchial  apertures  on  the 
sides  of  the  neck,  the  aorta  giving  off  a  regular  set  of  branchial  arteries 


DEVELOPMENT    OF    THE    NERVOUS    SYSTEM.  247 

which  take  their  course  to  the  edges  of  the  openings,  some  of  which 
are  afterwards  entirely  obliterated,  while  the  others  are  converted  into 
vessels  corresponding  with  the  regular  distribution  of  the  adult.  As  the 
organism  of  the  human  foetus  cannot  be  supposed  to  be  formed  with  the 
idea  of  providing  for  aquatic  respiration  like  the  embryos  of  fishes,  we 
can  no  longer  doubt  that  the  whole  series  of  phenomena  which  are  taking 
place  during  the  development  of  the  foetus,  do  not  result  from  any  special 
interference  of  Divine  agency  for  each  individual  occasion,  but  from  the 
action  of  fixed  and  general  laws. 

In  the  development  of  the  nervous  system,  to  which  we  must  next 
direct  our  attention,  we  shall  find  even  more  decided  proofs  of  this 
general  harmony  throughout  the  animal  kingdom. 

For  a  clear,  simple,  and  accurate  account  of  the  phenomena  attending 
the  development  of  the  ovum,  the  reader  should  consult  Dr.  Carpenter's 
excellent  work  on  physiology. 

In  order  to  understand  the  development  of  the  brain,  we  must  briefly 
trace  the  very  earliest  changes  which  take  place  in  the  germinal  vesicle, 
or  ovum.  A  portion  of  this  vesicle  becomes  opake  ;  the  opacity  is 
called  the  germinal  space — area  germinativa.  The  nucleated  cells  of 
this  spot,  at  first  uniformly  arranged,  so  that  the  whole  is  obscure,  soon 
begin  to  accumulate  on  the  circumference,  leaving  a  clear  space  in  the 
centte.  The  transparent  spot  assumes  an  oval  lunar  form,  transversely 
to  the  ovum.  If  we  examine  closely  the  material  of  the  germinal  spot 
at  thi^time,  we  find  that  it  consists  of  two  layers.  The  superior  is  the 
animal  or  serous  layer;  from  it  all  the  organs  of  animal  life  are  formed. 
The  inferior  is  the  vegetative  or  mucous  layer;  from  it  are  formed  all  the 
organs  of  vegetative  life.  The  transparent  line  is  confined  to  the  animal 
layer;  the  vegetative  layer  is  opake  throughout. 

We  may  next  observe  that  this  transparent  tract  assumes  a  pyriform 
shape,  and  the  edges  becoming  elevated,  a  groove  or  gutter  is  formed. 
The  edges  of  this  gutter  gradually  approximate,  at  first  in  the  centre, 
and  then  gradually  above  and  below,  so  as  to  form  a  canal ;  but  the 
edges  do  not  join  continuously  at  their  two  extremities.  At  the  superior, 
anterior,  or  cephalic  extremity,  they  are  separated,  so  as  to  form  dilata- 
tions placed  consecutively  to  one  another,  the  dimensions  of  which  in- 
crease from  behind  forwards.  At  the  inferior,  posterior,  or  caudal 
extremity,  they  are  equally  separated,  but  in  such  a  way  as  to  produce 
a  laminated  figure,  which  is  gradually  effaced.  The  clear  edges  of  this 
groove  seem  dotted  with  square  spots,  which  are  the  bodies  of  the  future 
vertebrae. 

At  very  early  periods  of  foetal  existence  there  is  no  appearance  of  any 
neurine  ;  the  parts  .corresponding  to  the  head  and  vertebral  column  are 
transparent,  and  contain  a  limpid  fluid;  about  the  fifth  or  sixth  week  the 
pia  mater  is  distinctly  perceptible,  forming  the  walls  of  the  canal  in 
which  the  fluid  is  contained,  arranged  in  the  head  so  as  to  form  three 
vesicles.  Tiedemann,  to  whom  we  are  indebted  for  almost  all  we  know 
regarding  the  development  of  the  human  foetal  brain,  considered  that  in 
the  first  division  into  cells  they  are  five  in  number.  But  Bischoff*  has 

*  Trait6  du  D6veloppement  del'Homme  et  des  Mammiferes  parT.  L.  G,  Bischoff,  traduit 
de  1'Allemand  par  A.  J.  L.  Jourdan.  1843,  p.  182.  .  -» 


248  HUMAN   BRAIN. 

proved  that  the  brain  consists  first  of  three  cells,  which  are  afterwards 
divided  into  five.  This  tertiary  division  of  the  encephalic  portion  of  the 
cerebro-spinal  axis  accords  with  the  tertiary  division  of  the  skull.  The 
skull,  as  mentioned  elsewhere,  consists  of  vertebra,  just  like  the  cervi- 
cal, dorsal,  and  lumbar  portions  of  the  vertebral  column.  The  number 
of  cranial  or  encephalic  vertebras  is  three  in  number,  and  hence  the 
same  number  of  primary  cerebral  cells.  The  anterior  cell  appears  first, 
and  is  shortly  afterwards  followed  by  two  others ;  soon  afterwards,  a  fis- 
sure appears  on  the  anterior  and  posterior  cell,  which  thus  divide  the  three 
cells  into  five.  The  anterior  and  superior  wall  of  the  anterior  cell  in- 
creases on  both  sides  of  the  mesial  line  with  more  rapidity  than  the 
posterior ;  so  that  when  we  look  at  it  from  above  it  represents  first  a 
double  vesicle,  with  a  feeble  median  depression,  dividing  it  into  two 
lateral  halves.  The  two  anterior  represent  the  olfactory  ganglia  and 
hemispheres;  the  two  middle,  the  optic  ganglia;  and  the  posterior,  the 
cerebellum  :  the  spinal  marrow  is  represented  by  a  long  canal  communi- 
cating with  the  cerebral  vesicles,  which  in  reality  are  but  swellings  of  a 
single  sac.  The  description  which  I  have  already  given  of  the  pia 
mater,  and  the  mode  in  which  it  first  forms  a  continuous  canal,  may 
here  be  again  referred  to. 

The  brain  of  all  Mammalia  has  this  vesicular  form  in  the  first  in- 
stance ;  the  embryos  of  the  rabbit  or  cat  are,  perhaps,  the  best  that  the 
student  can  select  for  his  own  observation.     Rolando  gives  a  very  ac- 
curate account  of  the  vesicular  form  of  the  fetal  bfcin  in 
Fig.  109.         Mammalia  and  in  birds. 

The  peculiar  form  and  general  appearance  of  the  foetus 
at  the  seventh  week  will  be  easily  comprehended  by  re- 
ferring to  fig.  109,  taken  from  Tiedemann,  who  represents 
it  as  an  oblongated  mass  slightly  curved  upon  itself,  ge- 
latinous, and  semitransparent. 

In  this  embryo,  which  was  about  seven  lines  in  length, 
Fcetus  of  seven     and  about  seven  weeks  old,  Tiedemann  was  enabled  dis- 
tTon  of  the^elk6"     tinctly  to  observe  the  structure  and  disposition  of  the  brain 

and  spinal  cord. 

The  cavity  provided  for  the  cord  was  situated  immediately  beneath 
the  integuments,  the  muscles  and  vertebral  arches  not  being  yet  formed. 
On  opening  this  cavity  by  means  of  a  fine  pair  of  scissors,  he  perceived 
the  dura  mater  nearly  dividing  the  cranium  into  two  equal  portions ;  the 
pia  mater  beneath  it  adhered  so  intimately  to  the  substance  of  brain  and 
spinal  cord,  that  it  was  difficult  to  detach  it  without  destroying  the  in- 
closed pulp,  the  general  form  of  which  may  be  clearly  understood  by 
referring  to  figs.  110  and  111. 

On  the  posterior  part  of  the  cord  a  longitudinal  fissure  existed,  into 
which  the  pia  mater  entered,  which  has  received  the  name  of  the  spinal 
canal ;  at  the  upper  part,  where  in  the  adult  it  forms  the  fourth  ventri- 
cle, a  thin  narrow  plate  or  flattened  fasciculus  of  neurine  arose  from 
either  side,  and  inclining  inwards,  touched,  without  uniting  with,  its 
fellow  ;  thus  forming  a  sort  of  arch  over  the  fourth  ventricle,  and  con- 
stituting the  rudiment  of  the  cerebellum  (c,  figs.  110  and  111),  about  one 
line  and  two-thirds  in  breadth. 


DEVELOPMENT   OF   THE   NERVOUS    SYSTEM.  249 

In  front  of  the  cerebellum  were  two  membraniform  productions,  the 
first  appearance  of  the  optic  tubercles  or  cor- 
pora quadrigemina,  taken  together  about  a 
line  in  breadth  and  one  in  length  (d).  The 
rudiments  of  the  thalami  (e),  in  the  shape  of 
two  rounded  protuberances,  were  next  in 
order,  the  space  between  them  being  that 
which  corresponds  to  the  third  ventricle.  In 
front  of  these  eminences  were  two  others,  in 
apposition  to  them,  about  a  line  in  length,  and 
apparently  the  rounded  extremities  of  the  an- 
tenor  part  of  the  crura  cerebri;  these  were  the  c.  cerebellum,  a.  Optic  tubercles, 

•    .      /  <•        i  -i  r\        \  or  quadngeminal  bodies,    e.  Optic 

Corpora  Striata  (fig.  110,  g).  thalami.   /.  Membraniform  hemi- 

From  the  corpora  striata  arose  two  thin  Jj^fi&^tifc  3^ 
membraniform  productions  of  neurine  curving  str^miL_posteT.ior  view  of  the 
backwards  and  inwards;  these  are  the  first  same  brain,  sPm  and  open  in  all 

P  ..       i  •       i  f  .1       t  its  length,     a  a.   Spinal  marrow. 

commencement  of  the  hemispheres  of  the  brain     &.  orifice  of  the  canal  of  the  spmai 

ffirr     11Q\  marrow,    c.  Swelling  of  the  spinal 

1™B*    »»*/•  marrow,  dd.  The  cerebellum  split 

At  this  early  period  there  are  no  traces  of    in  the  median  line,  and  laid  like  a 

J    "    „     ,  bridge  over  the  fourth  ventricle. 

the    COmmiSSUre     Of    the    Cerebellum    Or  Of  the       e  e.  The  quaclrigeminal  bodies  se- 


*fif]2rt3& 


cerebrum,  or  of  the  thalami,  or  of  the  longitu-  °ne  another  " 


dinal  commissure,  called  the  fornix. 

The  substance  of  the  brain  and  cord  examined  with  a  glass,  presented 
no  fibrous  appearance  ;  it  seemed  to  be  composed  of  extremely  minute 
globules.  It  does  not  assume  a  fibrous  appearance  until  the  commence- 
ment of  the  fourth  month.  Tiedemann  states  that  he  could  not  per- 
ceive any  appearance  of  the  cerebral  nerves,  which  he  accounts  for  on 
the  supposition  that  they  were  so  delicate  as  to  escape  detection  ;  but 
such  a  supposition  appears  to  me  unnecessary,  when  we  recall  to  mind 
the  facts  which  I  mentioned  in  the  early  part  of  this  work,  regarding  the 
development  of  the  nerves  in  the  first  instance  in  all  the  different  tis- 
sues, and  their  subsequent  union  with  the  brain  and  spinal  cord. 

In  the  following  details  I  have  adhered  generally  to  the  plan  of  de- 
scribing the  gradual  development  of  individual  parts  connectedly,  as 
bringing  the  whole  more  simply  before  the  eye  of  the  student  than  of 
particularly  detailing  each  change  as  it  takes  place  from  one  month  to 
another,  which  has  been  faithfully  done  by  Tiedemann  and  Serres,  to 
whom  I  must  refer  the  reader  for  greater  minuteness. 

It  may  be  laid  down  as  a  rule  that  the  spinal  cord  is  formed  previously 
to  the  brain,  not  merely  in  man,  but  in  all  the  orders  of  vertebrated  ani- 
mals. At  first  it  consists  of  two  cords,  not  united  posteriorly,  by  which 
a  deep  furrow  is  formed,  which  is  soon  converted  into  a  canal  by  the 
union  of  the  opposite  halves. 

This  canal  of  the  spinal  cord,  which  is  so  distinct  in  the  human  foetus 
until  the  fifth  month,  and  in  that  of  the  horse  and  the  calf  until  the  sixth, 
exists  permanently  of  a  certain  width  in  fishes,  reptiles,  and  birds.  In 
the  fcetal  state  of  the  human  embryo  it  is  obliterated  by  the  deposition 
of  successive  layers  of  gray  matter  secreted  by  the  pia  mater.  But  what 
is,  perhaps,  more  extraordinary  is,  that  the  cord  in  the  human  foatus  ex- 
tends to  the  extremity  of  the  coccyx  until  the  third  month,  when  it  ap- 


250  HUMAN    BRAIN. 

pears,  according  to  the  statement  of  M.  Serres,  to  rise  suddenly  to  the 
point  where  it  is  met  with  after  birth,  namely,  opposite  the  second  lum- 
bar vertebra.  The  os  coccygis,  which,  previous  to  this  period,  consisted 
of  seven  pieces,  suddenly  becomes  reduced  to  its  permanent  number, 
four. 

The  spinal  marrow  is  of  equal  calibre,  in  its  whole  extent  in  the  young 
embryos  of  all  classes  ;  it  is  without  enlargement  either  anteriorly  or 
posteriorly,  as  in  those  reptiles  which  do  not  possess  extremities,  as 
snakes,  &c.  This  appearance  corresponds  with  the  absence  of  extremi- 
ties at  this  period  of  existence  ;  for  as  soon  as  they  are  developed,  the 
cord  enlarges  at  those  points  with  which  their  large  nerves  are  connected. 

The  corpora  olivaria  are  not  formed  until  the  end  of  the  sixth,  or  be- 
ginning of  the  seventh  month.  The  interlacement  of  the  pyramidal 
fasciculi  is  visible  in  the  human  embryo  from  the  eighth  week.  In  rep- 
tiles and  fishes  there  is  no  interlacement  at  all. 

In  the  second  month  of  fetal  existence  the  fasciculi  of  the  spinal 
cord,  which  are  prolonged  into  the  brain,  are  curved  downwards  beneath 
the  optic  tubercles :  tlys  curve  remains  distinct  until  the  third  month. 
The  bundles  may  be  distinctly  traced  into  the  optic  thalami,  and  having 
become  more  voluminous  they  then  pass  into  the  corpora  striata,  from 
the  anterior  surface  of  which  they  may  be  seen  emerging,  and  spreading 
like  a  fan  to  form  the  hemispheres.  From  the  internal  and  inferior  side 
of  the  thalami,  or  from  the  continuation  of  each  crus,  a  fasciculus  of  fibres 
is  detached,  which  descends  into  the  mamillary  eminences.  These  re- 
flected on  themselves,  and  thus  directing  their  course  backwards,  form 
the  anterior  pillars  of  the  fornix,  or,  more  properly  speaking,  the  infe- 
rior longitudinal  commissure. 

All  the  other  fibres  of  the  crura,  which  are  very  numerous,  are  directed 
forwards  and  outwards,  passing  under  the  corpora  striata,  forming  the 
hemispheres  ;  and  at  the  posterior  part  they  join,  or  more  strictly  speak- 
ing form,  the  posterior  pillar  of  the  fornix.  In  doing  so  they  form  a  fold, 
which,  projecting  on  the  internal  surface  of  the  ventricle,  gives  rise  to 
that  appearance  which  is  called  the  cornu  Ammonis. 

The  corpus  callosum  or  commissura  magna  does  not  exist  in  the  brain 
of  the  fetus  in  the  second  month,  nor  even  in  the  early  part  of  the  third. 
Towards  the  end  of  the  third,  however,  it  makes  its  appearance  ;  at 
first  it  is  very  narrow  and  nearly  perpendicular.  In  its  growth  it  passes 
from  before  backwards.  By  the  seventh  month  its  fibres  may  be  traced 
in  connection  with  those  of  the  spinal  cord  through  the  medium  of  the 
crura  cerebri. 

From  the  description  already  given  of  the  brains  of  fishes,  reptiles, 
and  birds,  the  reader  is  aware  that  this  commissure  does  not  exist  in 
them. 

The  pituitary  gland  is  not  in  existence  in  the  second  month,  nor  even 
at  the  commencement  of  the  third  ;  but  it  appears  towards  the  end  of 
it,  forming  a  rather  large  soft  mass. 

The  very  gradual  manner  in  which  the  cerebellum  attains  its  ultimate 
complexity,  is  in  perfect  harmony  with  the  gradation  which  it  pursues 
in  the  animal  kingdom. 

About  the  third  month  the  cerebellic  fasciculi,  which  we  formerly  ob- 


DEVELOPMENT    OF   THE   NERVOUS    SYSTEM.  251 

served  just  touching  each  other,  are  now  united  so  as  to  form  a  concave 
mass  internally,  smooth  and  convex  externally,  but  without  any  appear- 
ance of  grooves  or  leaflets,  thus  accurately  corresponding  with  the  cere- 
bellum in  osseous  fishes,  such  as  the  carp,  cod,  &c. 

In  the  fourth  month  the  commissure  of  the  cerebellum  is  perceptible, 
and  is  about  a  line  in  width.  About  the  fifth  month  the  cerebellum, 
itself  about  seven  lines  in  breadth,  begins  to  assume  the  same  appear- 
ance as  that  of  the  skate  ;  for  grooves  appear  upon  the  surface,  which 
gradually  increase  in  depth  and  number,  till  at  the  sixth  month  the  stems 
and  branches  of  the  arbor  vita  become  apparent,  and  the  part  then  puts 
on  the  exact  appearance  of  that  of  birds. 

In  conclusion,  let  it  be  remembered  that  the  cerebellum  proceeds,  in 
the  first  instance,  from  the  spinal  marrow — in  fact,  from  the  two  fasci- 
culi which  are  earliest  apparent,  and  which  constitute  the  corpora  resti- 
formia. 

The  masses  of  neurine  which  correspond  with  the  tubercula  quadri- 
gemina  or  optic  tubercles  in  the  adult,  are  in  the  embryo  of  the  second 
month  merely  two  plates  bending  upwards  and  inwards,  but  not  yet 
covered  by  the  hemispheres,  and  in  apposition  only  in  the  mesial  line, 
their  union  not  being  complete  until  the  end  of  the  third  month,  when, 
becoming  convex  externally,  they  gradually  increase  in  size  and  become 
united. 

At  this  period  they  correspond  in  appearance  with  the  optic  tubercles 
in  fishes  and  in  birds ;  and  it  is  not  until  the  seventh  month  that  we  can 
perceive  any  division  into  nates  and  testes,  or  into  four  bodies  instead 
of  two  ;  and  even  at  this  period  they  are  scarcely  covered  by  the  hemi- 
spheres, so  that  they  now  resemble  those  of  the  Rodentia. 

The  anterior  ganglions  of  the  cord  or  corpora  striata,  at  the  end  of  the 
second  month,  not  being  yet  covered  by  the  hemispheres,  are  clearly  to 
be  seen  (fig.  112).  Towards  the  end  of  the  third  month,  however, 
when  they  measure  two  lines  and  a  half  in  length  (figs.  113,  114,  115, 
116),  the  membranous  hemispheres' are  partially  extended  over  them. 
These  protuberances,  which  are  solid  throughout,  are  united  by  a  trans- 
verse band  representing  the  posterior  commissure,  and  their  increase 
from  this  period  is  in  exact  correspondence  with  the  progressive  deve- 
lopment of  the  hemispheres.  The  commissura  mollis  was  not  observed 
by  Tiedernann  until  the  ninth  month.  The  Wenzels  are  said  to  have 
met  with  this  commissure  in  the  fifth,  and  again  in  the  seventh  month. 

The  pineal  gland  is  not  to  be  seen  previous  to  the  fourth  month,  when 
it  appears  in  the  form  of  a  small  flattened  round  body,  the  peduncles  of 
which,  extremely  thin,  are  seen  arising  from  the  inner  edge  of  the  supe- 
rior surface  of  the  optic  thalami. 

This  body  is  not  met  with  in  fishes,  though  it  is  in  many  reptiles,  as 
the  hawk-bill  tortoise,  wall  lizard,  and  ringed  snake,  as  also  in  birds, 
and  invariably  in  the  brains  of  the  Mammalia,  varying  in  size,  figure, 
and  structure. 

In  volume  it  is  much. larger  in  proportion  to  the  size  of  the  brain  in 
the  ruminating  animals  than  in  man. 

The  thalami  nervorum  opticorum  or  posterior  ganglions  of  the  cord, 
are  just  perceptible  at  the  second  month.  In  the  commence'ment  of  the 


252 


HUMAN   BRAIN. 


third  they  become  more  voluminous,  and  are  partly  covered  by  the 
hemispheres,  which  structures,  being  in  the  first  instance  mere  layers  of 
neurine  shooting  out  from  the  hinder  part  of  the  corpora  striata  and 
thalami,  give  to  the  corpora  striata  an  appearance  of  greater  size  and 
prominence  than  they  seem  to  possess  afterwards,  when  the  hemispheres 
have  become  nearly  as  thick  as  themselves.  At  the  period  of  birth  they 
appear  sunk  amid  the  substance  of  the  hemispheres,  which  then  bound 
the  anterior  part  of  the  space  left  between  them  and  the  corpora  striata 
and  thalarni,  and  which  has  been  so  incorrectly  designated  a  ventricle 
or  bag. 

Fig.  112.          Fig.  113.         Fig.  114.  Fig.  115.  Fig.  116. 


Fig.  112. — Brain  of  an  embryo  of  nine  weeks,  a  a.  The  two  principal  columns  of  the  spinal  marrow, 
separated  from  one  another  by  a  longitudinal  fissure,  b  b.  Cerebellum,  c.  Parts  which  give  rise  to  the 
quadrigeminal  bodies,  d.  Thalami  optici.  e.  Membranous  hemispheres,  turned  backwards  and  inwards. 

Fig.  113. — Brain  of  an  embryo  of  twelve  weeks,  seen  in  the  cranium,  a  a.  Fragments  removed  from 
the  cranium,  which  has  been  opened,  b.  Spinal  marrow,  c.  Swelling  of  the  spinal  marrow,  which  is 
bent  inwards,  d.  Cerebellum,  f.  Elevation  which  gives  rise  to  the  quadrigeminal  bodies,  g.  Crus 
cerebri,  or  a  cord  of  the  spinal  marrow  which  comes  down  again,  and  is  directed  forwards  h.  Mem- 
branous hemisphere  of  the  cerebrum,  broken  down  behind  and  before ;  .it  does  not  yet  cover  the  emi- 
nences destined  to  form  the  quadrigeminal  bodies. 

Fig.  114. — Brain  and  spinal  marrow  of  the  same  fetus  seen  posteriorly,  a  a.  Spinal  marrow,  with  its 
posterior  longitudinal  fissure,  b.  Cerebellum,  and  beneath  it  the  fourth  ventricle,  c.c.  Hemispheres  of 
the  cerebrum,  d.  Eminences  which  are  to  become  the  quadrigeminal  tubercle,  with  the  fissure  which 
they  present. 

Fig.  115. — Inferior  surface  of  the  brain  of  the  same  fetus,  a  a.  Spinal  marrow,  with  the  anterior  longi- 
tudinal fissure,  b  b.  Swelling  of  the  spinal  marrow,  bent  forward,  c  c.  Peduncles  of  the  cerebellum, 
which  arise  from  the  cerebellum,  d  d.  Cerebellum  e  e.  Peduncles  of  the  cerebrum.  /.  Mamillary 
eminences,  g.  Pituitary  gland,  h  h.  Anterior  lobes  of  the  cerebrum,  i  i.  The  posterior  and  round  ap- 
pendices which  represent  the  middle  and  posterior  lobes. 

Fig.  116. — View  of  the  superior  surface  of  the  brain  of  the  same  fetus :  the  membranous  hemispheres 
are  separated  from  one  another  and  laid  aside,  a  a.  The  two  principal  cords  of  the  spinal  marrow,  b. 
Posterior  longitudinal  fissure,  c  c.  Cerebellum  d  d.  Masses  which  are  to  form  the  quadrigeminal  bodies. 
ee.  Thalami  optici.  ff,gggg.  Membranous  hemispheres  separated  from  one  another  and  laid  on  the 
sides,  h  h.  The  two  corpora  striata.  which  are  a  little,  wider  anteriorly,  and  divided  into  two  parts  by  a 
slight  fissure,  i.  Commissure  of  the  two  hemispheres  and  commencement  of  the  corpus  callosum.  k  k. 
Lateral  ventricles,  with  the  radiated  folds  of  the  under-surface  of  the  hemispheres. 

The  anterior  commissure  does  not  exist  in  the  second  month  ;  but  in 
the  third  it  appears  like  a  thin  delicate  thread,  and  its  development 
proceeds  in  accordance  with  that  of  the  corpora  striata  and  thalami. 

Although  in  the  preceding  descriptions  of  the  corpora  striata  and 
thalami  we  have  had  frequent  occasion  to  speak  generally  of  those 
layers  of  neurine  which  ultimately  form  the  hemispheres,  it  may  be  desira- 
ble to  give  a  more  detailed  account  of  them.  This  is  particularly  im- 
portant as  calculated  to  do  away  with  the  false  notions  that  have  been 
entertained  on  the  subject  of  the  ventricles,  as  well  as  to  convey  clearer 
impressions  on  the  difference  between  the  figurate  and  convoluted  sur- 
faces of  the  brain.  .These  ends,  indeed,  can  in  no  better  way  be  ac- 
complished than  by  following  out  the  development  of  the  hemispheres 


DEVELOPMENT   OF   THE   NERVOUS    SYSTEM.  253 

of  the  brain.  At  any  rate  I  think  that  if  the  reader  will  attentively 
.compare  the  description  which  I  have  given  on  the  subject  of  the  adult 
brain,  of  the  relations  of  the  hemispheres  to  the  ganglia  of  the  cord,  or 
corpora  striata  and  thalami,  no  doubt  will  remain  in  his  mind  as  to  the 
correctness  of  the  statement  made  at  the  commencement  of  this  work, 
namely,  that  the  ventricles  are  no  more  entitled  to  the  name  of  bags 
than  the  space  left  between  any  two  convolutions  of  the  surface  of  the 
hemispheres. 

In  the  foetus  of  the  second  month  we  perceive  springing  out  from  the 
under  part  of  the  corpora  striata  on  each  side,  a  thin  delicate  membrane, 
consisting  of  medullary  neurine,  which  is  reflected  backwards  and  in- 
wards, scarcely  covering  them,  invested  with  pia  mater:  this  is  the 
rudiment  of  the  hemispheres  (fig.  112).  In  the  commencement  of  the 
third  month  these  membraniform  hemispheres  completely  cover  the 
corpora  striata,  and  towards  the  end  of  the  month,  they  have  extended 
over  the  thalami,  not  having  yet  reached  the  optic  tubercles  (figs  113,  114, 
115  and  116). 

Fig.  117.  /  ,    Fig.  118. 


Fig.  117.— Superior  surface  of  the  brain  of  a  fetus  of  fourteen  or  fifteen  weeks,  a  a.  Spinal  marrow. 
b.  Peduncles  of  the  cerebellum  separated  from  one  another,  from  above  downwards,  which  brings  the 
fourth  ventricle  into  view.  e.  The  cerebellum,  which  has  not  yet  any  fissures,  d  d.  The  right  hemi- 
sphere of  the  cerebrum,  which  does  not  yet  cover  the  quadrigeminal  mass. 

Fig  118. — Side  view  of  the  brain  of  a  fcetus  of  twenty-seven  weeks.  B.  Cerebrum.  E.  Cerebellum, 
ii.  Spinal  marrow,  s.  Corpus  olivare.  T.  Corpus  pyramidale,  \v  Corpus  restiforrne.  £.  Annular  pro- 
tuberance. The  fissura  Sylyii  are  very  deep,  and  extend  to  a  great  distance  on  the  sides ;  they  lodge  the 
middle  cerebral  arteries,  which  distribute  almost  all  their  branches  to  the  deep*seated  parts  of  the  ence- 
phaloii,  namely,  to  the  corpora  striata.  The  olfactory  nerve  descends  from  the  fissura  Sylvii. 

During  the  fourth  month  (fig.  117)  they  have  advanced  as  far  as  the 
anterior  edge  of  the  optic  tubercles,  but  they  do  not  cover  them  entirely 
until  the  sixth,  when  they  have  extended  as  far  as  the  cerebellum  (fig. 
118).  At  this  period  we  may  perceive  on  the  surface  corresponding  to 
the  falx  major,  some  grooves  or  furrows  which  are  the  first  steps  to- 
wards the  formation  of  the  convolutions.  The  upper  and  lateral  surfaces 
still  remain  perfectly  smooth.  At  the  seventh  month  the  convolutions 
are  very  imperfectly  developed,  though  the  hemispheres  now  cover  the 
cerebellum  entirely,  and  upon  this  division  of  the  cerebral  mass,  depres- 
sions appear  here  and  there,  the  rudiments  of  the  convolutions  and  fossa, 
into  which  the  pia  mater  dips.  The  fissure  Sylvii  are  distinct,  lodging 


254  HUMAN   BRAIN. 

the  middle  arteries  of  the  brain,  which  send  numerous  branches  into  the 
interior. 

In  the  eighth  month  the  hemispheres  which  cover  the  cerebellum,  and 
are  prolonged  even  beyond  its  posterior  border,  are  two  inches  eleven 
lines  in  length,  two  inches  one  line  in  breadth,  and  one  inch  ten  lines 
deep.  On  examining  their  inferior  surface,  the  anterior,  middle,  and 
posterior  lobes  may  be  distinctly  seen,  the  boundaries  of  each  being  well 
marked. 

At  nine  months  the  hemispheres  are  three  inches  and  four  lines  in 
length,  and  two  lines  in  breadth  ;  they  have  now  exactly  the  same  form 
as  in  the  adult,  and  are  covered  writh  convolutions  and  anfractuosities. 

After  these  details,  it  must  be  evident  trwt  the  hemispheres  are  formed 
from  before  backwards,  and  from  without  inwards ;  that  at  first  they 
consist  only  of  a  thin  membranous  layer  of  neurine,  reflected  upon  itself 
from  behind  forwards,  and  from  without  inwards  ;  that  they  increase  in 
thickness  and  volume  very  gradually  ;  and  that  as  they  are  developed 
they  extend  themselves,  first  over  the  corpora  striata,  and  afterwards 
over  the  thalami,  optic  tubercles,  and  cerebellum,  so  that  in  the  end 
they  entirely  cover  all  these  parts. 

We  observe  precisely  the  same  plan  adopted  in  the  formation  of  the 
hemispheres  of  the  brain  throughout  the  Vertebrata,  except  that  they  are 
arrested  at  different  stages  of  the  development  in  different  species,  which 
the  human  embryo  merely  assumes  for  a  short  period,  and  passes  on  to  a 
more  elevated  type. 

Professor  Retzius,  of  Stockholm,  has  given  the  following  account  of 
the  development  of  the  hemispheres,  which  is  more  minute  than  that  of 
Tiedemann.  I  am  unable  to  say  whether  it  is  more  accurate:* — 

"  In  the  first  period,  which  corresponds  with  the  second  and  third 
months,  only  the  anterior  lobes  form;  in  the  second  period,  which  is 
comprised  in  the  end  of  the  third  month,  in  the  fourth,  and  in  a  small 
portion  of  the  fifth,  the  two  middle  lobes  appear:  and  after  this  time  the 
posterior  lobes.  During  the  first  period  the  descending  horns  of  the 
lateral  ventricles,  and  the  pedes  hippocampi,  are  wanting;  these  are 
added  in  the  second  period.  During  a  great  portion  of  the  first  period, 
the  hemispheres  do  not  cover  the  thalami  nervorum  opticorum;  in  the 
second  period  they  completely  overlap  these  parts,  approach  the  large 
corpora  quadrigemina,  cover  their  anterior  part,  and  then  descend  by 
the  side  of  the  cerebral  nucleus,  (cone  or  stem,)  and,  as  it  were,  fold 
round  it.  If  we  examine  a  brain  at  this  period  of  development,  we 
might,  from  its  external  appearance,  imagine  that,  the  posterior  margin 
of  the  hemispheres  corresponds  to  their  persistent  posterior  ends  and 
margins,  i.  e.,  to  those  which  are  their  posterior  margins  in  their  per- 
fectly developed  state.  But  it  is  not  so.  If  we  open  the  brain  we  come 
at  once  to  the  descending  horns  of  the  lateral  ventricles,  in  which  are 
the  rudiments  of  thp  great  pedes  hippocampi.  At  a  later  period,  in  the 
fourth  month,  a  small  superficial  notch  is  formed  at  the  posterior  margins 
of  the  hemispheres;  and  that  part  of  this  margin  which  is  above  the 
notch  is  the  first  rudiment  of  the  posterior  lobes  of  the  hemispheres. 

*  British  and  Foreign  Quarterly  Medical  Review,  vol.  xxii.  p.  503. 

. 


,  I 

DEVELOPMENT  OF  THE  NERVOUS  SYSTEM.         255 

These,  which  are  thus  for  a  long  time  only  rudimental,  begin  above  the 
middle  lobes,  gradually  take  in  their  posterior  margin,  follow  it  down,  as 
development  advances,  by  the  sides  of  the  cerebral  nucleus,  and  terminate 
at  that  part  of  the  middle  lobes  which  meet  the  pedes  hippocampi.  Even 
in  the  brain  of  the  mature  foetus,  as  well  as  in  the  fully  developed  brains 
of  older  persons,  the  posterior  lobes  are  very  clearly  separated  from  the 
middle  lobes  by  a  branching  furrow,  which  is  especially  distinct  on  the 
vertical  side  of  the  hemisphere  which  lies  next  to  the  falx." 

Having  entered  generally  into  the  composition  of  the  cerebral  mass 
in  fishes,  reptiles,  birds,  and  the  mammalia,  I  consider  it  unnecessary  to 
dwell  more  fully  upon  the  subject  at  present  than  to  point  out  a  few  of 
the  analogies  between  them  and  the  human  foetus. 

The  skate  presents  one  of  the  most  decided  specimens  of  a  structure 
analogous  to  the  foetal  or  rudimentary  hemisphere  of  the  higher  classes, 
in  the  two  tubercular  enlargements  which  are  placed  immediately  in 
front  of  the  optic  tubercles,  and  with  which  the  peduncles  of  the  olfac- 
tory nerves  are  connected  as  in  the  human  subject. 

These  bodies  are  hollow,  and  the  walls  of  the  cavity  are  formed  by  a 
membranous  layer  of  neurine  reflected  backwards  and  inwards,  into 
which  the  fibres  of  the  crura  cerebri  expand  as  in  the  human  embryo. 

In  the  carp  we  have  also  observed  rudimentary  hemispheres. 

The  rudimentary  hemispheres  of  the  reptiles  are  equally  interesting 
when  viewed  in  relation  to  this  subject.  In  the  crocodile,  each  hemi- 
sphere represents  a  membranous  sac  containing  within  it  the  optic 
thalami,  the  pineal  gland,  and  the  corpora  striata,  from  which  ganglia 
the  hemispheres  appear  to  'arise,  thus  corresponding  accurately  with  the 
same  part  in  its  state  of  evolution  at  the  third  month  of  foetal  existence 
in  the  human  being,  presenting  the  reflection  of  neurine  which  consti- 
tutes the  hemispheres,  extending  to  the  same  point  behind,  and  covering 
the  corpora  striata  and  thalami,  but  leaving  the  optic  tubercles  exposed. 
And  so  we  might  in  the  same  manner  go  on  multiplying  examples  of  the 
truth  of  the  law  of  progressive  development  of  the  hemispherical  gan- 
glia: more  than  has  been  said  seems  unnecessary. 

The  corpora  marnraillaria  do  not  appear  until  the  end  of  the  third 
month,  and  then  not  divided  as  they  are  after  birth,  but  simple  and  homo- 
geneous. 

The  above  facts  which  I  have  laid  before  my  readers  on  the  authority 
of  Tiedemann,  Serres,  BischofF,  and  others,  will,  I  think,  thoroughly 
convince  them  of  the  truth  of  the  law  which  I  stated  at  the  commence- 
ment of  this  section  regarding  the  gradual  development  of  the  brain  and 
spinal  cord  on  one  simple  and  uniform  type:  and  that  the  complicated 
structure  which  we  meet  with  in  the  human  adult,  is  at  an  early  period 
of  foetal  existence,  as  simple  in  its  general  arrangement  as  many  of  the 
permanent  forms  of  the  lower  vertebrated  animals,  and  that  in  its  develop- 
ment Nature  appears  to  have  pursued'  the  same  plan  which  she  has 
adopted  in  thet>rganization  of  each  individual  in  her  vast  family,  gradu- 
ally adding  one  part  after  another,  and  at  the  same  time  concentrating  the 
whole,  each  fresh  addition  changing  the  appearance  of  the  several  parts, 
so  that  unless  the  chain  be  observed  from  its  very  commencement,  all 


256  HUMAN   BRAIN. 

the  analogies  which  are  so  palpable  when  we  proceed  step  by  step  are 
obscured,  and  even  made  altogether  incapable  of  demonstration. 

Let  me  not,  however,  be  misunderstood,  when  speaking  of  the  addi- 
tion of  fresh  parts,  for  the  brain  of  man  even  in  its  state  of  perfect 
development  consists  of  the  same  number  of  ganglia  as  that  of  the  Ver- 
tebrata  in  general,  though  the  amazing  size  of  the  hemispherical  ganglia 
and  the  cerebellum,  with  the  addition  of  fresh  commissures,  give  to  the 
human  brain  an  appearance  wholly  unlike  that  of  the  reptile  and  the 
fish. 


257 


PART    X. 

PHYSIOLOGY  OF  THE  CEREBRO-SPINAL  AXIS. 

THIS  is  a  subject  which  every  candid  physiologist  approache/with 
great  diffidence,  for  though  much  has  been  done  in  the  last  ten  years, 
still  much  remains  in  doubtful  obscurity. 

In  the  anatomical  sections  of  this  work  I  have  purposely  introduced 
much  physiology,  in  order  to  give  more  interest  to  the  anatomy  than  is 
usually  attached  to  mere  details  of  structure,  without  reference  to  func- 
tion, so  that  in  this  section  it  will  only  be  necessary  to  give  a  summary 
of  what  has  been  more  or  less  touched  upon  previously. 

The  sources  of  our  information  on  the  functions  of  the  nervous  sys- 
tem are  fourfold. 

First.  Observation  of  the  parts  composing  it  in  the  lower  animals, 
and  the  relation  which  they  bear  to  those  of  man,  considered  in  connec- 
tion with  the  development  of  their  organs  of  sense  and  muscular  actions. 
This  source  we  have  already  availed  ourselves  of  in  the  section  on  com- 
parative anatomy,  and  observed  how  clearly  the  development  of  the 
nervous  centre  keeps  pace  with  the  increase  of  the  animal  powers  ;  and 
I  need  only  advert  to  the  important  discoveries  of  Mr.  Newport,  among 
others,  to  remind  my  readers  that  this  is  one  of  our  most  unerring  sources 
of  information. 

Secondly.  Experiments  on  living  animals. 

Thirdly.  Pathological  facts. 

Fourthly.  Observations  between  the  relations  of  the  size  of  the 
human  cranium  in  individuals,  and  their  manifestations  of  intellect.  Also 
observations  on  the  relation  between  the  external  configuration  of  the 
cranium  in  individuals,  and  their  manifestations  of  particular  degrees  of 
intellectual  power,  propensities,  and  sentiments. 

Though  the  deductions  which  are  made  from  experiments  on  living 
animals  are  so  liable  to  error  that  reliance  must  not  be  placed  upon  them 
as  unerring  sources  of  knowledge,  ihey  have  afforded  very  important 
and  valuable  information  on  this  subject.  I  do  not  agree  with  the  ob- 
jections which  Mr.  Combe  has  urged  against  the  experiments  on  the 
brain  as  useless  in  the  elucidation  of  its  functions,  for  it  appears  true 
that,  notwithstanding  the  various  sources  of  error  to  which  experiments 
on  living  animals  are  exposed,  some  very  important  facts  have  been 
elicited,  which,  taken  in  conjunction  with  those  derived  from  compara- 
tive anatomy,  pathology,  and  observation  during  life,  have  afforded  col- 
lateral evidence  of  the  separate  offices  of  different  portions  of  the  brain 
and  nervous  system.  As  regards  our  knowledge  of  the  functions  of  the 
17 


258  HUMAN    BRAIN. 

nerves  and  the  spinal  cord,  experiments  have  been  invaluable  ;  and  in 
reference  to  the  encephalon,  when  taken  in  connection  with  the  facts 
of  comparative  anatomy,  they  have  shed  much  light  on  the  subject, 
particularly  those  of  MM.  Flourens  and  Bouillaud.  In  so  far  as  this 
mode  of  investigation  is  admissible,  the  results  obtained  by  these 
authors  are  perhaps  the  best  authenticated  and  the  most  satisfactory  of 
any. 

If  we  were  not  bound  to  receive  with  the  greatest  caution  the  conclu- 
sions of  every  experimental  physiologist,  knowing  how  liable  even  the 
strictly  honest,  (among  whom  both  the  above-mentioned  authors  may  be 
classed,)  are  to  see  results  as  they  expect  them  to  be,  and  not  as  they 
really  occur,  we  might  be  induced  to  believe,  after  reading  their  works, 
that  fr  great  deal  more  of  the  functions  of  the  nervous  system  must  be 
known  than  is  actually  the  case. 

We  must  guard  against  extending  the  mischief  which  has  been  done 
by  several  recent  authors,  who  have  referred  to  the  whole  of  the  results 
and  inferences  as  if  they  were  so  many  firmly-established  facts  in  the 
science  of  physiology. 

From  pathology  we  might  naturally  expect  surer  evidence;  but  even 
here  the  physiologist  who  carefully  examines  its  records  is  doomed  to 
disappointment. 

It  is  clear  that  if,  in  uniform  accordance  with  the  derangement  or  ob- 
literation of  individual  functions  during  life,  morbid  alterations  of  indi- 
vidual portions  of  the  nervous  system  were  met  with  after  death,  no  surer 
evidence  could  be  procured  of  the  connection  between  function  and 
organic  structure.  But  no  certain  light  has  yet  shone  on  physiology 
from  this  source. 

The  last,  or  fourth  source  mentioned  as  affording  us  knowledge  of 
the  functions  of  the  brain,  can  only  yield  us  instruction  as  to  the  office 
of  its  surface.  But,  as  we  shall  see  hereafter,  the  mass  of  evidence  in 
favor  of  the  belief  that  the  great  hemispherical  ganglion  or  cortical  sub- 
stance of  the  brain  is  the  immediate  agent  in  all  mental  operations,  is,  in 
my  own  opinion,  so  conclusive,  that  it  becomes  next  a  most  interesting 
question  whether  different  portions  of  this  ganglion  play  different  parts 
in  the  production  of  mental  phenomena.  Now  I  candidly  avow  that 
the  more  I  have  examined  the  facts  adduced  by  the  supporters  of  this 
theory,  the  more  I  am  inclined  to  believe  that  its  general  principles  are 
correct  and  philosophical.  I  entirely  agree  with  that  talented  observer, 
Mr.  G.  Combe,  that  "  Phrenology,  in  its  evidence,  rests  on  the  same 
foundation  as  the  practice  of  medicine.  The  existence  of  disease  can- 
not in  general  be  determined  by  weight  or  measure,  and  the  characters 
of  diseases  can  be  judged  of  only  by  their  appearances,  or  the  symptoms 
which  they  present.  The  organs  affected — the  degree  to  which  they 
are  affected — and  the  extent  to  which  medicines  act  on  them — are  all 
estimated  by  the  exercise  of  observation  and  reflection  on  mere  symp- 
toms. In  the  practice  of  medicine,  anatomy,  physiology  and  pathology 
shed  their  light  to  help  the  judgment  in  its  estimates,  but  they  do  not 
reveal  the  theory  of  medicine  a  priori,  nor  do  they  render  it  a  demonstra- 
tive science." 
-  "The  same  general  laws  of  evidence  must  necessarily  apply  to  the 


PHYSIOLOGY.  259 

study  of  phrenology.  The  mental  manifestations  are  not  ponderable  nor 
measurable  any  more  than  the  capacity  for  pain  or  pleasure,  or  the  powers 
of  hearing  or  sight,  are  so.  We  estimate  the  degree  in  which  these 
susceptibilities  and  capacities  are  possessed  by  different  individuals,  and 
regard  our  knowledge  as  substantial,  and  we  must  of  necessity  learn  to 
estimate  the  force  of  the  mental  manifestations  by  a  similar  exercise  of 
observation  and  reflection,  or  remain  forever  ignorant  of  mental  science." 
(See  Phren.  Journ.,  vol.  x.  p.  556.  On  the  nature  of  the  evidence  by 
which  the  functions  of  different  parts  of  the  brain  may  be  established,  by 
Geo.  Combe.) 

In  the  course  of  our  observations  of  the  composition  and  properties  of 
neurine,  and  on  the  essential  elements  of  a  nervous  system,  the  follow- 
ing fundamental  principles  have  been  established,  and  need  only  be 
adverted  to  in  the  present  section. 

1.  That  vesicular  neurine  is  the  source  of  power. 

2.  That  medullary  neurine  is  the  conductor  of  it. 

3.  That  medullary  neurine  is  also  the  conductor  of  those  impressions 
which  call  forth  the  power  of  the  vesicular  neurine. 

4.  That  the  vesicular  neurine  is  collected  in  masses  of  variable  form 
and  size — the  ganglia. 

5.  That  the  medullary  neurine  is  moulded  into  cords  and  bands — the 
nerves  and  commissures. 

In  an  inquiry  like  the  present,  the  surest  path  to  sound  opinions  must 
be  first  to  investigate  the  office  and  mode  of  action  of  such  organs  as  the 
nerves,  which  are  sufficiently  isolated  to  enable  us  to  experiment  on  them 
without  being  in  danger  of  injuring  adjoining  organs  of  the  same  kind, 
and  performing  separate  offices,  and  thus  interfering  with  the  result  of 
the  experiments;  and  afterwards  to  prove  the  physiology  of  the  central 
portions,  where  the  problem  is  more  difficult  to  solve. 

Indeed,  the  facility  of  exposing  the  nerves,  and  the  striking  results 
which  follow  their  injury,  show  the  important  part  which  they  play  as 
conductors  of  stimuli.  And  even  Herophilus,  Erasistratus,  and  Galen, 
perceived  that  there  was  a  flow  of  power  from  the  centres  of  the  nervous 
system  and  the  muscles,  which  produced  their  contractions,  and  from 
the  organs  in  general  to  the  centres  of  power  which  produced  the  sensa- 
tions. Further  researches  have  only  confirmed  the  fact  that  they  are 
mere  conductors,  not  originating  the  power  of  contraction  in  muscles,  or 
perceiving  sensations  in  themselves,  but  in  the  first  place  conducting  a 
stimulus  which  calls  the  resident  power  of  muscles,  that  of  shortening 
themselves,  into  action,  and  in  the  second  conducting  a  something  to  a 
certain  point,  where  it  is  converted  into  a  sensation  and  perceived;  the 
course  of  these  influences,  namely,  the  one,  that  of  the  stimulus  to  mus- 
cular contractions,  proceeding  from  the  centre  to  the  circumference,  the 
other,  the  producer  of  sensations,  from  the  circumference  to  the  centre. 

And  though  the  fact  that  we  can  produce  contraction  in  a  muscle  by 
pinching  a  nerve  cut  off  from  its  connection  with  the  brain,  but  still  in 
connection  with  the  muscle,  might  seem  to  prove  that  the  stimulus  to 
contraction  actually  resides  in  the  nerve,  and  is  merely  called  forth  by 
the  brain,  yet  the  experiments  of  Miiller  (see  Muller,  op.  cit.y  p.  7917) 
show  that  the  divided  nerves  lose  this  power  after  they  have  remained 


260  HUMAN    BRAIN. 

. 

unconnected  for  a  short  time,  so  that  the  previous  power  of  exciting 
contractions  must  have  been  derived  from  the  nervous  centres,  and  not 
generated  by  the  nerves  themselves.  The  experiments  of  Sir  C.  Bell, 
Magendie,  and  Mayo,  have  proved  that  there  are  nerves  subservient  to 
sensation — sensiferous  or  sensory  nerves,  and  nerves  of  voluntary  motion. 
The  physiological  researches  of  Whytte,  Prochaska,  and,  more  perfectly, 
Marshall  Hall,  confirmed  by  the  anatomical  observations  of  Grainger, 
Carpenter,  and  Newport,  have  established  another  system  of  nerves  for 
the  involuntary — the  conservative  movements  of  the  body,  under  the  title 
of  the  excito-motory  system  of  nerves.  All  sound  research  and  careful 
experiment  prove  that  a  nerve  in  the  whole  extent  of  its  course,  whether 
that  course  is  between  the  fibres  of  a  muscle,  in  the  canal  of  a. bone,  in 
the  substance  of  the  spinal  cord,  in  the  crura  of  the  brain,  or  in  the 
masses  of  the  hemispheres,  always  performs  one  and  the  same  office, 
conducting  always  in  one  and  the  same  direction. 

The  spinal  nerves  are  connected  with  the  spinal  cord  by  anterior  and 
posterior  roots.  Each  root  consists  of  two  sets  of  nerves,  making,  there- 
fore, four  sets  of  spinal  nerves  functionally  distinct.  The  two  anterior 
are  the  conductors  of  volition  from  the  brain  to  the  voluntary  muscles, 
and  the  conductors  of  a  stimulus  to  muscular  action  independent  of  voli- 
tion from  the  ganglia  of  the  spinal  cord — the  efferent  nerves  of  spinal 
power.  The  posterior  roots  are  also  binary  in  their  functional  power — 
nerves  of  sensation,  conducting  impressions  to  the  brain,  and  recognized 
by  the  conscious  being:  and  conductors  of  impressions  to  the  spinal 
ganglia  from  parts  requiring  the  protective  action  of  muscles  too  import- 
ant to  be  left  to  the  control  of  mind — the  incident  nerves  of  spinal  im- 
pressibility. 

The  spinal  cord  is  a  series  of  ganglionic  centres,  structurally  homo- 
logous and  functionally  analogous  to  the  jointed  ganglionic  cord  of  the 
articulata,  and  although  we  are  unable  to  point  out  any  corresponding 
anatomical  lines  of  demarkation  between  them,  they  are  as  functionally 
distinct  as  the  auditory,  optic,  and  olfactory  ganglia  of  the  brain.  For 
instance,  those  cervical  centres  which  give  origin,  with  such  undeviating 
regularity  in  the  Mammal,  to  the  phrenic  nerve,  endowing  that  nerve  as 
a  conductor  with  power  that  keeps  the  diaphragm  in  unremitting  and 
unwearied  action  during  the  whole  of  life,  must  possess  the  power  of 
acting  independently  of  those  lumbar  centres  from  which  the  nerves  of 
the  generative  system  arise,  and  by  which  various  muscles  are  brought 
into  numerous  and  convulsive  actions  during  the  act  of  copulation.  In 
the  latter  instance  unrestrained  action,  so  injurious  to  our  moral  natures, 
in  its  excess  brings  its  own  punishment — disease  and  softening  of  the 
.cord  ;  in  the  former,  constant  action  is  essential  to  life,  and  the  power  is 
only  exhausted  by  death  itself. 

Wherever  there  are  distinct  centres  of  power,  there  are  also  connect- 
ing commissures.  The  transverse  commissures  of  the  spinal  cord,  con- 
necting corresponding  ganglia  on  opposite  sides  of  the  mesial  line,  are 
easily  demonstrated.  Longitudinal  commissures  connecting  them  toge- 
ther from  below  upwards  must  also  exist,  though  it  is  not  so  easy  to  dis- 
tinguish them  from  the  longitudinal  fibres  of  the  volitional  and  sensiferous 


PHYSIOLOGY.  261 

nerves.  It  is  quite  possible  that  the  posterior  columns  are  the  longi- 
tudinal commissures  which  connect  these  ganglia  together,  and  with  the 
cerebrum  and  cerebellum,^as  the  fibres  of  these  columns  terminate  in 
both  the  grand  divisions  of  the  encephalon,  though  principally  in  the 
cerebellum. 

The  spinal  cord  consists,  then,  of  ganglia,  nerves,  transverse  and 
longitudinal  commissures,  perfectly  similar  to  the  longitudinal  commis- 
sures which  connect  the  jointed  cord  of  the  articulata. 

The  medulla  oblongata  consists  of  three  ganglia  on  each  side  of  the 
mesial  line — six,  therefore,  in  all.  The  olivary  bodies,  most  probably 
the  lingual  ganglia,  the  restiform  or  pneumogastric  ganglia,  the  posterior 
pyramidal  bodies  or  auditory  ganglia.  The  olivary  ganglia  are  connected 
with  the  rest  of  the  cerebral  ganglia  by  means  of  the  olivary  commissures, 
and  the  important  office  of  those  ganglia,  if  my  hypothesis  is  correct, 
that  they  preside  over  the  consensual  movements  of  the  tongue,  as  an 
organ  of  speech,  explains  the  reason  of  such  a  perfect  communication 
with  the  rest  of  the  encephalon.  Between  the  pneumogastric  ganglia 
and  the  brain  the  commissural  communication  is  not  so  distinct,  and 
there  does  not  appear  to  be  the  same  physiological  reason  to  expect  it. 

The  auditory  ganglia  are  imbedded  in  the  sensory  tract;  but  un- 
doubtedly some  of  these  fibres  which  we  have  heretofore  considered  as 
belonging  solely  to  this  system  of  nerves,  must  be  regarded  as  belong- 
ing to  that  system  of  longitudinal  commissures  which  we  have  seen  so 
distinctly  carried  out  in  the  brain. 

The  next  anatomical  division  we  come  to  is  the  pons  Varolii.  This, 
though  evidently  a  great  transverse  commissure,  must  also  be  an  instru- 
ment of  power  through  the  medium  of  its  vesicular  neurine  ;  and  though 
we  are  unprepared  to  define  the  nature  of  its  power,  it  must  hold  some 
relation  to  transmission  of  motor  and  sensory  impressions  by  the  tracts 
which  in  the  spinal  cord  conduct  them. 

Cerebellum. — The  extensive  surface  of  vesicular  neurine  which  con- 
stitutes the  ganglionic  portion  of  this  encephalic  centre,  shows  that  it 
must  perform  some  very  important  office  in  the  animal  economy  ;  that  it 
must,  in  fact,  be  a  ganglion,  or  series  of  ganglia,  of  great  power.  Its 
extensive  nervous  and  commissural  connections  also  support  this  opin- 
ion. The  motor  and  sensory  tracts,  as  they  form  the  restiform  bodies 
and  plunge  through  the  substance  of  its  great  transverse  commissure, 
have  a  connection  with  its  nucleated  dynanaic  vesicle.  By  the  inter- 
cerebral  commissure  the  cerebellum  is  intimately  associated  with  the 
optic,  the  anterior  and  posterior  cerebral,  and  the  hemispherical  ganglia. 

From  what  has  been  already  said  in  the  sections  on  comparative  and 
human  anatomy  regarding  the  function  of  this  organ,  the  reader  will  be 
prepared  for  my  opinion  on  this  subject. 

There  can,  I  think,  be  little  doubt  but  it  is  a  regulator  and  co-ordi- 
nator  of  muscular  action  on  the  one  part,  most  probably  by  means  of 
the  central  portion  of  the  cerebellum,  viz.,  the  superior  and  inferior 
vermiform  processes.  On  the  second  part,  it  certainly  would  appear 
to  hold  some  relation  to  the  generative  function.  The  pathological  and 
other  facts  adduced  by  Drs.  Gall,  Vimont,  and  Broussais,  on  this  subject, 


262  HUMAN    BRAIN. 

are  very  striking,  and  almost  as  conclusive  as  all  other  physiological 
evidence.* 

The  locus  niger  in  the  cms  cerebri  is  the  next  ganglion  for  our  con- 
sideration; it  is  the  serial  homologue  and  analogue  of  the  anterior  peaks 
of  gray  matter  of  the  spinal  cord.  It  is,  I  suppose,  the  seat  of  the  ex- 
cito-motor  power  of  the  third  pair  of  nerves,  the  importance  of  which  in 
relation  to  the  instinctive  and  conservative  movements  of  the  eyeball 
need  not  be  insisted  on  here. 

The  tubercula  quadrigemina  or  optic  tubercles,  we  may  fairly  con- 
clude, are  the  instruments  by  which  the  physical  impressions  of  light 
received  by  the  retina  are  converted  into  sensations  of  light,  color, 
form,  &c. 

The  optic  thalami  and  corpora  striata,  or  anterior  and  posterior  cere- 
bral ganglia,  are  the  next  in  rotation.  With  regard  to  the  office  of  these 
nervous  centres,  we  have  already  had  occasion  to  consider  the  thalamus 
as  the  essential  ganglion  of  the  sensory  tract,  as  the  corpus  striatum  is 
of  that  of  the  motor  tract.  And  I  am  quite  disposed  to  adopt  the  inge- 
nious and  philosophical  theory  of  my  friend,  Dr.  Carpenter,  as  enunciated 
in  his  review  of  Mr.  Noble's  work  in  the  October  number  of  the  British 
and  Foreign  Quarterly  Medical  Review  for  1846. 

The  anterior  and  posterior  cerebral  ganglia  are  regarded  by  Dr.  C.  as 
forming  part  of  the  series  of  sensorial  centres,  of  which  we  have  seen 
other  members  in  the  olfactory,  optic,  and  auditory  ganglia.  That  they 
are  independent  centres  of  action,  not  mere  appendages  to  the  hemi- 
spheric ganglia,  appears  from  the  large  quantity  of  vesicular  neurine  which 
they  contain  ;  and  that  the  corpora  striata  are  so,  further  appears  from 
the  absence  of  any  correspondence  in  size  between  them  and  the  hemi- 
spheric ganglia.  Thus  in  fishes,  we  find  that  the  corpora  striata  make 
up  the  principal  bulk  of  the  second  pair  of  masses  ;  in  reptiles,  birds, 
and  the  lower  Mammalia,  they  still  form  a  very  large  portion  of  that 
which  is  commonly  termed  the  cerebrum  ;  and  their  subordinate  aspect 
in  man  and  the  higher  Mammalia  is  solely  due  to  the  large  relative  de- 
velopment of  the  hemispheric  ganglia.  On  the  other  hand,  there  is 
scarcely  any  rudiment  of  the  thalami  optici  to  be  discovered  in  fishes; 
their  proportional  size  increases  in  reptiles,  birds,  and  the  lower  Mam- 
malia;  but  it  is  only  in  man  that  their  dimensions  approach  those  of  the 
corpora  striata.  The  peculiar  connection  of  the  thalami  optici  with  the 
posterior  columns  of  the  spinal  cord,  and  their  great  development  in  man, 
suggest  the  idea  that  they  are  the  ganglia  of  tactual  sensation  ;  whilst 
the  connection  of  the  corpora  striata  with  the  anterior  columns  indicates 
their  relation  with  the  motor  function.  The  very  close  relation  between 
the  thalami  optici  and  the  corpora  striata — corresponding,  as  Messrs. 
Todd  and  Bowman  have  suggested,  with  that  which  exists  between  the 
posterior  and  anterior  peaks  of  gray  matter  in  the  spinal  cord — harmonizes 
\vell  with  the  fact  that  the  greater  number  of  muscular  movements  are 
directed  by  common  sensation;  whilst  the  special  connection  established 

*  On  the  Functions  of  the  Cerebellum,  by  Drs.  Gtvll,  Vinxont,.  and  Bcoussajp,  translated 
from  the  French  by  George  Cornb,e,  1837. 


PHYSIOLOGY.  263 

by  the  inter-cerebral  commissure  between  the  corpora  striata  and  the 
optic  ganglia  (tuberculaquadrigemina)  explains  the  peculiar  influence  of 
the  sense  of  light  in  directing  certain  classes  of  muscular  actions.  The 
communication  which  is  formed  by  the  medullary  substance  of  the  cere- 
brum between  these  ganglia  and  the  hemispheric  ganglia  seems  to  be  the 
medium  by  which  sensations  are  transmitted  to  the  latter,  to  become  the 
stimulus  of  intellectual  operations,  and  by  which  the  influence  of  volition 
is  transmitted  downwards  to  excite  muscular  motions  through  the  cor- 
pora striata. 

The  whole  chain  of  sensory  ganglia  is  regarded  by  Dr.  C.  as  not  only 
the  instrument  by  which  sensations  are  received,  but  also  as  the  centre 
of  those  automatic  muscular  movements  which  differ  from  those  of  a 
simply  reflex  character,  in  being  dependent  upon  sensation.  To  this 
head,  he  refers  the  purely  instinctive  actions  of  the  lower  animals,  as 
well  as  a  variety  of  actions  performed  by  the  human  being,  both  in 
health  and  disease  ;  such  as  the  consensual  movements  of  the  eyes,  the 
regulation  of  the  laryngeal  muscles  in  the  production  of  vocal  sounds, 
the  convulsive  movements  in  hydrophobia,  brought  on  by  the  sight  or 
sound  of  water,  &c.  &c.  And  he  considers  the  actions  which  become 
automatic  by  habit,  as  executed  through  the  same  channel;  each  move- 
ment being  directly  prompted  by  the  sensation  with  which  it  has  become 
associated. 

We  come  lastly  to  those  important  ganglia  which  crown  and  cover 
in  the  rest — the  hemispherical.  If  there  is  one  point  in  the  physiology 
of  the  brain  more  unequivocally  demonstrated  than  another,  it  is  that 
these  ganglia  are  the  instruments  of  the  mind — the  portion  of  the  brain 
in  which  sensations  are  converted  into  perceptions,  and  give  rise  to 
ideas.  Comparative  anatomy ;  developmental  anatomy  ;  experiments 
on  living  animals  ;  observations  on  its  size  and  form,  as  indicated  by 
the  size  and  form  of  the  skull ;  and  last,  but  not  least,  pathology, — ail 
afford  a  mass  of  overwhelming  evidence  that  this  portion  of  the  brain, 
and  this  only,  is  the  cerebral  organ  of  intellectual  power. 

Miiller,  whose  authority  on  all  physiological  subjects  is  interesting, 
after  speaking  of  the  general  evidence  in  favor  of  a  belief  that  the  intel- 
lectual faculties  reside  in  the  cerebral  hemispheres,  says,*  "  It  has, 
however,  been  proved  by  direct  experiment  that  such  is  their  seat. 
The  experiments  of  Flourens  are  here  also  especially  instructive,  and 
Hertwig  has  in  the  essential  points  done  no  more  than  confirm  them. 
The  hemispheres  are  insensible  both  to  puncture  and  incisions.  That 
part  of  the  brain  in  which  the  sensations  are  converted  into  ideas,  and 
the  ideas  hoarded  up,  to  appear  again,  as  it  were,  as  shadows  of  the 
sensations,  is  itself  devoid  of  sensibility." 

Further  on,  he  says,  "  The  experiments  of  Hertwig  confirm  M. 
Flourens'  observations.  Wounds  of  the  hemispheres  (in  a  dog)  excited 
no  pain,  unless  they  extended  to  the  base  of  the  brain,  when  signs  of 
pain  were  exhibited.  M.  Hertwig  removed  both  hemispheres  in  a  dog: 
the  animal  did  not  move  from  the  spot  voluntarily,  but  was  thrown  into 
a  state  of  complete  stupor;  if  irritated,  it  moved  a  few  steps,  and  then 

*  P.  834,  op.  cit. 


264  HUMAN   BRAIN. 

fell  again  to  the  ground  in  a  sleepy  state.  It  did  not  hear  even  the 
report  of  a  pistol.  M.  Hertwig  removed  the  upper  part  of  the  hemi- 
spheres in  a  pigeon  ;  sight  and  hearing  were  abolished,  and  the  animal 
sat  in  one  spot,  as  if  asleep.  He  fed  it:  peas,  if  placed  merely  within 
the  beak,  were  not  swallowed ;  but  they  were,  if  laid  upon  the  tongue, 
owing  to  reflex  action;  the  muscles  were  but  slightly  enfeebled  ;  the 
bird  stood  firmly,  and  flew  when  thrown  into  the  air.  This  state  en- 
dured for  a  fortnight,  when  the  hearing  and  sensibility  in  a  great  mea- 
sure returned  ;  this  pigeon  lived  three  months.  A  hen,  in  which  Hert- 
wig had  cut  away  both  hemispheres  nearly  to  the  base  of  the  brain,  was 
found  to  be  deprived  of  sight,  hearing,  taste,  and  smell.  It  sat  constantly 
in  one  spot,  and  was  as  if  dead,  until  strongly  roused,  when  it  moved  a 
few  steps.  The  animal  lived  in  this  state  of  stupor,  without  its  senses 
being  restored,  for  three  months.  M.  Schoeps  has  instituted  similar 
experiments." 

It  is  evident  from  these  experiments,  and  from  the  effects  of  pressure 
on  the  cerebral  hemispheres  in  man,  that  they  are  the  seat  of  the  mental 
functions;  that  in  them  the  sensorial  impressions  are  not  merely  per- 
ceived, but  are  converted  into  ideas ;  and  that  in  them  resides  the  power 
of  directing  the  mind  to  particular  sensorial  impressions,  the  faculty  of 
attention. 

In  considering  the  question,  is  the  brain  the  organ  of  the  mind  ?  I 
must  say,  with  Mr.  Combe,  that  the  physiologist  u  regards  man  as  he 
exists  in  this  world,  and  desires  to  investigate  the  laws  which  regulate 
the  connection  between  the  mind  and  its  organs,  but  without  attempting 
to  discover  the  essence  of  either,  or  the  manner  in  which  they  are  united." 

And,  in  connection  with  this  subject,  let  us  ever  bear  in  mind  that 
we  are  not  conscious  of  the  existence  and  functions  of  the  organs  by 
which  the  mind  operates  in  this  life,  and,  in  consequence,  many  acts  ap- 
pear to  us  to  be  purely  mental,  which  experiment  and  observation  prove 
incontestably  to  depend  on  corporeal  organs. 

"  For  example,  in  stretching  out  or  withdrawing  the  arm,  we  are 
conscious  of  an  act  of  the  will,  and  of  the  consequent  movement  of  the 
arm,  but  not  of  the  existence  of  the  apparatus  by  means  of  which  our 
volition  is  carried  into  execution." 

"  Experiment  and  observation,  however,  demonstrate  the  existence  of 
bones  of  the  arm,  curiously  articulated  and  adapted  to  motion  ;  of  mus- 
cles endowed  with  power  of  contraction  ;  and  of  three  sets  of  nerves,  at 
least,  &c." 

"  All  that  a  person  uninstructed  in  anatomy  knows  is,  that  he  wills 
the  motion,  and  it  takes  place  :  the  whole  act  appears  to  him  to  be  pure- 
ly mental,  and  only  the  arm  or  thing  moved  is  conceived  to  be  corpo- 
real. Nevertheless,  it  is  positively  established  by  anatomical  and  phy- 
siological researches  that  this  conclusion  is  erroneous — that  the  act  is 
not  purely  mental,  but  accomplished  by  the  instrumentality  of  the  vari- 
ous organs  now  enumerated.  In  like  manner  every  act  of  vision  in- 
volves a  certain  state  of  the  optic  nerve,  and  every  act  of  hearing,  a 
certain  state  of  the  internal  ear;  yet  of  the  existence  and  functions  of 
these  organs,  we  obtain  by  means  of  consciousness  no  knowledge  what- 


ever/' 


PHYSIOLOGY.  265 

Now  the  phrenologist,  says  Dr.  Combe,  goes  "  one  step  further  in  the 
same  path,  and  states,  that  every  act  of  the  will,  every  flight  of  imagi- 
nation, every  glow  of  affection,  and  every  effort  of  the  understanding, 
in  this  life,  is  performed  by  means  of  cerebral  organs  unknown  to  us 
through  consciousness,  but  the  existence  of  which  is  capable  of  being 
demonstrated  by  experiment  and  observation  ;  in  other  words,  that  the 
brain  is  the  organ  of  the  mind — the  material  condition,  without  which  no 
mental  act  is  possible  in  the  present  world." 

"The  mind  sees  through  the  medium  of  the  eye,  just  as  it  thinks  or 
feels  through  the  medium  of  the  brain  ;  and  as  changes  in  the  condition 
of  the  eye  deteriorate  or  destroy  the  power  of  vision  without  any  affec- 
tion of  the  principle  of  mind,  the  obvious  inference  follows,  that  in  like 
manner  may  changes  in  the  condition  of  the  brain  destroy  the  power  of 
feeling  or  of  thinking,  and  yet  the  mind  itself,  or  souly  remain  essentially 
the  same." 

The  most  decisive  facts  in  proof  that  it  is  the  surface  qf  the  brain  or 
the  hemispherical  ganglion  which  directly  ministers  to  intellect,  are  de- 
rived from  pathology,  and  especially  the  consequence  of  inflammation  of 
the  membranes,  as  we  shall  see  when  we  consider  the  diseases  of  the 
brain.  The  varying  effects  of  apoplexy  afford  also  strong  evidence  in 
favor  of  this  opinion.  I  will  very  briefly  state  the  argument  now.  If 
the  effusion  of  blood  take  place  on  the  surface  of  the  brain,  the  mind  is 
more  or  less  disturbed,  and  if  the  effusion  is  extensive,  the  intellect  is 
buried  for  ever;  but  if  the  effusion  is  limited  to  the  medullary  substance, 
the  mind,  having  recovered  the  first  effect  of  the  general  shock,  remains 
perfect,  though  its  conducting  instruments  are  paralyzed. 

The  first  philosopher  who  attempted  to  prove  that  the  brain  does  not 
minister  to  the  intellect  as  a  single  organ,  but  as  a  combination  of  or- 
gans, was  Gall  ;  and  I  think  he  deserves  the  gratitude  of  mankind  for 
his  labors,  though  all  his  views  may  not  ultimately  prove  correct. 

The  science  which  Gall  advocated  is  now  well  known  under  the  title 
of  phrenology.  Those  who  have  not  given  their  serious  attention  to  this 
subject  have  a  sort  of  indefinite  idea  that  phrenology  is  some  occult  sci- 
ence, by  means  of  which  its  professors  pretend  to  be  able  to  judge  of  a 
man's  character  by  an  examination  of  the  bumps  upon  his  head.  This 
is  the  phrenology  of  the  superficial  and  the  idle,  who,  not  having  indus- 
try enough  to  investigate  for  themselves,  set  up  a  baseless  shadow,  and 
then  take  credit  for  the  facility  with  which  they  overthrow  it.  This  is 
not  the  science  of  phrenology,  but  the  phantom  of  their  own  imagina- 
tion. In  the  first  place,  the  term  bump,  in  reference  to  the  surface  of 
the  skull,  has  no  place  in  the  vocabulary  of  the  phrenologist.  The  prac- 
tical phrenologist  judges  of  character  by  space  rather  than  by  mere  ele- 
vation or  depression. 

It  must  always  be  borne  in  mind  that  the  physiological  principles  upon 
which  phrenology  is  founded,  may  be  perfectly  correct,  and  nevertheless 
its  professors  may  make  great  mistakes  in  their  application. 

Spurzheim  himself  says,  "  The  true  principles  of  a  science  may  be 
established,  but  those  who  apply  them  may  err." 

"  The  art  of  surgery  is  positive,  yet  there  cannot  be  a  doubt  but  that 
legs  have  been  amputated  which  might  have  been  saved,  and  in  the 


266  HUMAN    BRAIN. 

practice  of  their  art  all  surgeons  have  not  the  same  dexterity.  Every 
physician  has  not  equal  facility  in  distinguishing  disease  ;  the  healing 
art  nevertheless  exists." 

u  I  do  not  conceive  that  phrenology  has  reached  perfection  now 
[1826],  nor  do  I  expect  that  its  application,  even  when  perfect,  will 
always  be  without  error.  I  have  been  frequently  obliged  to  rectify  my 
judgment,  but  I  always  endeavor  to  profit  by  my  mistakes." 

Those  who  really  wish  to  understand  phrenology,  and  judge  of  its 
correctness,  ought  to  read  the  works  of  Gall,  Spurzheim,  Combe,  and, 
lastly,  the  admirable  treatise  of  Mr.  Noble  ;  for  arguments  on  the  other 
hand  they  should  also  peruse  a  critique  of  the  last-mentioned  work  in 
the  British  and  Foreign  Quarterly  Medical  Review,  vol.  22 ;  in  which 
the  writer  most  ably  advocates  the  necessity  of  employing  comparative 
anatomy  in  the  study  of  cerebral  physiology. 

My  reasons  for  believing  that  there  must  be  a  great  deal  of  truth  in 
phrenology  are  fourfold.  First,  I  have  received  from  practical  phreno- 
logists, and  especially  the  late  worthy  Mr.  Deville,  such  accurate  cha- 
racters of  individuals  known  to  me,  but  unknown  to  them,  that  I  cannot 
believe  the  accounts  I  received  could  be  the  result  of  accident  and 
conjecture,  which  must  have  been  the  case  if  phrenology  is  untrue. 

Secondly.  Phrenology  alone — as  it  appears  to  me — can  account  for 
all  the  varieties  of  insanity,  especially  monomania. 

Thirdly.  The  facts  which  have  been  collected  by  the  late  Mr.  Deville, 
showing  that  the  brain  will  alter  its  form  at  any  period  of  life. 
Fourthly.  The  existence  of  longitudinal  commissures. 
In  Mr.  Deville's  collection  there  are  above  twenty  casts  which  prove 
an  alteration  in  form  ;  as  far  as  I  am  able  to  judge,  they  correspond  with 
the  mental  and  moral  exercise  which  the  brain  experienced  in  the  period 
during  which  the  changes  were  taking  place.  Few  medical  men  are 
aware  of  the  immense  number,  and  the  importance,  of  the  facts  esta- 
blished by  that  collection  ;  and  whether  phrenology  is  true  or  false,  such 
a  collection  should  not  be  lost  to  the  nation.  The  government  has 
been  most  liberal  in  granting  sums  for  the  purchase  of  antique  marbles 
and  specimens  of  natural  history  for  the  British  Museum — all  important 
objects  for  the  improvement  of  the  people  ;  and  they  would  confer  a 
lasting  benefit  to  science,  and,  through  it,  to  the  nation  at  large,  were 
they  to  add  this  to  our  national  treasures. 

If  phrenology  is  true,  insanity  on  its  first  ingress  is  frequently  not  a 
disease  of  the  whole  brain,  but  of  only  a  part  of  it.  The  first  effect  of 
inflammation  is  to  excite  to  an  unnatural  degree  the  natural  function  of 
an  organ.  The  function  of  the  organ  thus  exalted  obtains  a  mastery 
over  the  rest.  For  instance,  a  man,  from  defective  education,  combined 
\vith  hereditary  tendency,  allows  his  love  of  approbation,  his  vanity,  in 
other  words,  to  grow  with  his  growth,  and  strengthen  with  his  strength, 
gradually  becoming  the  sole  ruling  principle  of  life  :  at  last  it,  instead 
of  reason,  so  completely  guides  and  regulates  all  his  actions,  that  they 
are  contrary  to  reason,  and  justly  called  the  acts  of  a  lunatic.  Yet  all 
this  may  go  on  with  reasoning  faculties  so  acute,  that  he  conceals  the 
dominant  feeling  of  his  breast,  the  mainspring  of  all  his  actions,  and  in 
a  court  of  law  defies  any  one  to  prove  him  insane. 


PHYSIOLOGY.  267 

The  great  amelioration  which  has  been  effected  in  the  condition  of 
the  lunatic  has  been  founded  on  this  principle,  that  none  are  so  mad  as 
to  be  incapable  of  appreciating  kindness.  Throughout  all  the  admirable 
and  interesting  reports  of  Dr.  Conolly,  it  will  be  seen  that  this  has  been 
the  guiding  principle  of  his  boldly  humane  treatment.  The  first  thing, 
says  this  admirable  man,  is  to  gain  the  confidence  of  your  patient ;  and 
that  once  obtained,  you  may  do  anything  with  him. 

Now  if  this  is  true,  (and  no  one  who  has  treated  the  insane  on  these 
principles  doubts  it,)  so  is  it  equally  true  that  they  may  be  awed  by 
punishment  and  even  acknowledge  its  justice.  Only  the  last  time  I 
had  the  pleasure  of  visiting  that  noble  asylum,  Hanwell,  I  listened  with 
much  interest  to  a  lunatic  whom  we  met  in  the  grounds.  He  began  by 
requesting  Dr.  Conolly  to  procure  his  release  from  the  Asylum,  and  then 
went  on  in  a  rambling  manner,  reasoning  on  things  and  circumstances 
which  had  no  existence,  showing  his  mental  aberration ;  but  he  finished 
by  saying,  as  an  argument  for  his  being  allowed  his  liberty,  that  he  had 
always  conducted  himself  with  propriety  while  there,  which  was  perfectly 
true.  This  sense  of  right  and  wrong  was  as  perfect  as  ever,  and  this 
sense  enabled  him  to  conduct  himself  properly.  But  if  we  had  supposed 
that  the  circumstance  of  his  being  lunatic  gave  him  a  license  for  any 
conduct,  and  freed  him  from  all  responsibility,  would  he  have  been  so 
anxious  to  conduct  himself  properly  ?  And  if  he  were  told  that  the  law 
of  the  land  would  not  take  notice  of  an  improper  act,  even  if  that  act 
amounted  to  the  murder  of  a  fellow-creature,  he  would  not  feel  the  same 
reason  for  self-control. 

Mental  philosophers  have  always  admitted  that  if  a  man  through  im- 
perfect education  has  never  had  his  reasoning  faculties  called  forth,  the 
instrument  of  that  power  becomes  more  or  less  atrophied,  and  the  power 
is  more  or  less  lost.  For  instance,  take  two  boys  born  of  the  same 
parents,  and  with  the  same  or  nearly  the  same  original  capacity;  sup- 
pose them  differently  educated,  the  one  brought  up  in  the  fields,  and  all 
mental  culture  neglected,  the  other  trained  for  a  learned  profession. 
When  these  two  have  arrived  at  maturity,  oblige  them  to  change  places, 
and  the  incapacity  of  the  brain  of  the  peasant  would  only  be  surpassed 
by  incapacity  of  the  muscular  system  of  the  student.  The  same  applies 
to  moral  as  to  intellectual  culture.  And  hence  the  same  importance  of 
early  education  for  the  formation  of  moral  strength  as  for  the  formation 
of  intellectual  or  muscular  strength.  But  phrenology  goes  further  than 
merely  to  insist  on  the  importance  of  educating  the  child.  It  goes  fur- 
ther also  in  tracing  moral  insanity  to  its  real  cause.  It  teaches'us  that 
the  child  inherits  more  or  less  of  the  mental  or  moral  capacity  of  the 
parent,  just  as  much  as  he  inherits  the  form  of  the  face  and  physical 
constitution.  And  as  personal  beauty  may  be  more  or  less  spoiled  and 
effaced  by  evil  education,  (and  I  refer  to  the  moral  and  mental  educa- 
tion of  circumstances  and  example,)  so  may  the  brain,  with  its  mental 
and  moral  faculties,  be  deteriorated  and  debased  by  the  same  causes. 
But  phrenology  also  inculcates  that,  although  it  has  pleased  the  Almighty, 
for  some  good  and  wise  purpose,  to  ordain  that  not  merely  the  bodily 
diseases  of  parents,  but  even  their  mental  and  moral  imperfections,  shall 
more  or  less  descend  to  their  children,  such  hereditary  imperfections. 


268  HUMAN   BRAIN. 

whether  of  the  intellectual,  the  muscular,  or  the  mental  organs,  may  be 
corrected  by  careful  attention. 

It  has  not  been  my  object  so  much  to  prove  the  truth  of  phrenology, 
as  to  show  that,  if  true,  the  following  must  also  be  so — that  though  the 
form  of  the  brain  is  not  alike  in  all  children  at  birth,  any  more  than  their 
dispositions  or  intellectual  capacities  are  alike,  the  form  of  their  brain 
may  be  altered  and  improved,  as  the  disposition  and  the  intellect  may 
be,  at  any  period  of  life,  by  education  and  restraint. 

Lastly,  with  regard  to  the  office  of  the  commissures,  this  is  implied  in 
the  name  by  which  they  are  known.  The  structure  of  these  parts,  their 
comparative  anatomy,  analogy,  and  the  few  pathological  facts  that  have 
been  recorded,  bear  us  out  in  the  view  I  have  taken  of  their  office  as 
conductors  of  nervous  power,  as  the  media  of  establishing  communica- 
tion between  one  portion  of  the  encephalic  mass  and  another,  and,  in 
this  way,  intimately  connected  with  the  faculty,  possessed  by  man  espe- 
cially, of  comparing  and  reasoning  upon  the  various  impressions  received 
by  the  different  portions  of  the  hemispheres. 


269 


PART  XI. 

DISEASES  OF  THE  BRAIN. 

IN  undertaking  this  division  of  my  subject,  I  am  afraid  that  by  some 
I  shall  be  considered  as  stepping  beyond  the  proper  boundaries  of  sur- 
gical practice.  To  such  I  must  observe  that  every  surgical  disease  re- 
quires more  or  less  of  medical  treatment ;  that  no  surgeon  is  competent 
to  treat  an  injury  of  the  head  affecting  the  brain,  who  is  ignorant  of 
cerebral  pathology  ;  that  the  distinction  between  medicine  and  surgery 
is  artificial;  and  that  a  distinction  between  diseases  arising  from  external 
violence  and  from  internal  disease  is  false  and  mischievous.  One  of  the 
first  principles  instilled  into  my  medical  mind  by  my  respected  master, 
Mr.  Travers,  was  the  necessity  of  studying  medicine  at  the  hospital  with 
the  same  diligence  and  attention  as  surgery.  The  interest  I  have  felt 
from  the  time  I  first  heard  Spurzheim  demonstrate  the  brain  in  1826  has 
induced  me  to  attend  to  the  pathology  of  this  subject  more  than  perhaps 
I  should  otherwise  have  done.  These  observations  are  made,  not  to 
prove  fitness  for  the  task  I  have  undertaken,  but  simply  to  explain  that 
I  do  not  allow  that  the  fact  of  my  practising  as  a  surgeon  is  any  excuse 
of  incompetency. 

For  many  years  I  have  thought  much  upon  the  functions  of  the  brain, 
and  endeavored  to  observe  the  phenomena  which  attend  the  disturbance 
of  those  functions.  In  detailing  the  information  I  have  obtained  by  ob- 
servations and  reading,  I  must  rely  on  the  same  kind  indulgence  for  the 
imperfect  execution  of  my  task,  which  has  been  so  liberally  accorded  to 
my  former  labors. 

In  this  outline  of  the  diseases  of  the  brain,  the  following  arrangement 
will  be  adopted  : — 

1.  Anaemic  affections. 

2.  Hyperaemic. 

3.  Convulsive.  ^  >. 

4.  Organic. 

This  arrangement,  like  every  other  that  has  been  adopted,  is  of 
course  liable  to  objections.  Each  of  these  affections  will  occasionally 
run  one  into  the  other,  so  that  the  lines  of  distinction  are  lost;  neverthe- 
less, in  a  practical  point  of  view,  I  hope  it  will  on  the  whole  be  found 
advantageous. 

I  have  not  divided  the  history,  diagnosis,  and  treatment  of  these  dis- 
eases so  strictly  as  some  authors  have  done.  My  reason  for  which  is, 
that  it  is  impossible  to  maintain  these  divisions,  if  the  subject  is  much 


270  HUMAN   BRAIN. 

illustrated  by  cases;  and  I  believe  that  the  interest  of  the  reader  is  more 
continuously  kept  up  by  mingling  them  together. 

Before  we  consider  these  different  affections  separately,  it  will  be  ad- 
visable to  determine,  as  far  as  possible,  whether  the  quantity  of  blood 
within  the  cranium  ever  varies,  and  whether  the  cerebral  substance  can 
be  compressed.  The  student  who  has  seen  something  of  disease  prac- 
tically, and  is  conversant  with  the  expressions  which  the  practical  phy- 
sician employs,  but  who  is  not  well  acquainted  with  the  literature  of 
medicine,  will  be  astonished  that  these  points  should  have  been  ever 
questioned.  It  has,  however,  been  questioned,  and  the  result  is,  that 
for  some  years  it  was  admitted,  as  an  established  doctrine  of  physiology, 
that  the  quantity  of  blood  in  the  cranium  never  varies,  and  that  the  brain 
is  incompressible.  It  will  be  necessary  to  show  here  the  grounds  upon 
which  they  are  now  abandoned.  The  theory  has  had  a  mischievous 
tendency  in  a  practical  point  of  view  ;  for  instance^Dr.  Clutterbuck,  in 
his  article  on  cerebral  apoplexy  in  the  Cyclopa?dia  of  Practical  Medicine, 
says,  that  "no  additional  quantity  of  blood  can  be  admitted  into  the 
vessels  situated  in  the  brain,  the  cavity  of  the  skull  being  already  com- 
pletely filled  by  its  contents.  A  plethoric  state,  or  over-fullness  of  the 
cerebral  vessels  altogether,  though  often  talked  of,  can  have  no  real  ex- 
istence; nor,  on  the  other  hand,  can  the  quantity  of  blood  within  the 
vessels  of  the  brain  be  diminished :  no  abstraction  of  blood,  therefore, 
whether  it  be  from  the  arm  or  other  part  of  the  general  system,  or  from 
the  jugular  veins  (and  still  less  from  the  temporal  arteries),  can  have  any 
effect  on  the  blood-vessels  of  the  brain  so  as  to  lessen  the  absolute  quan- 
tity of  blood  contained  within  them." 

I  cannot  conceive  a  more  dangerous  doctrine  in  the  practice  of  medi- 
cine, particularly  coming  from  such  an  authority  as  Dr.  Clutterbuck,  and 
one  who  is  generally  so  fond  of  bleeding.  The  profession  is  indebted  to 
Dr.  George  Burrows  for  dispelling  these  illusions. 

Monro  Secundus,  of  Edinburgh,  is  generally  believed  to  have  been 
the  first  who  propounded  this  doctrine.  He  observes,*  "As  the  sub- 
stance of  the  brain,  like  that  of  the  other  solids  of  our  body,  is  nearly 
incompressible,  the  quantity  of  blood  within  the  head  must  be  the  same 
at  all  times,  whether  in  health  or  disease,  in  life  or  after  death,  those 
cases  excepted  in  which  water  or  other  matter  is  effused  or  secreted 
from  the  blood-vessels:  for  in  these  cases  a  quantity  of  blood,  equal  in 
bulk  to  the  effused  matter,  will  be  pressed  out  of  the  cranium." 

Monro  regarded  the  skull  as  if  it  were  a  perfect  air-tight  sphere,  unin- 
fluenced by  the  pressure  of  the  atmosphere  ;  and  he  used  to  illustrate 
his  theory  by  showing  to  his  class  a  glass  ball  filled  with  water,  which 
he  inverted  to  show  them  that  not  a  drop  of  water  would  escape  through 
the  aperture. 

Abercrombie,  who  supported  this  view,  does  not  appear  to  have  insti- 
tuted any  positive  experiments,  but  to  have  founded  his  opinion  on  the 
experiments  of  Dr.  Kellie,  published  in  vol.  i.  of  the  Transactions  of 
the  Med.  Chir.  Society  of  Edinburgh. 

Dr.  Burrows  first  promulgated  his  valuable  and  conclusive  researches 

*  Observations  on  the  Nervous  System,  Alex.  Monro,  M.  D.',  1793. 


PATHOLOGY.  271 

on  this  subject  in  his  Lumlean  Lectures,  delivered  at  the  College  of  Phy- 
sicians, March,  1843,  published  in  the  thirty-second  volume  of  the 
Medical  Gazette,  p.  146,  and  to  them  I  must  refer  my  readers  for  a  full 
exposition  of  the  opinions  of  preceding  observers,  their  experiments, 
and  the  conclusions  they  draw  from  them.  Dr.  Burrows  has  since  en- 
tered more  fully  into  the  subject  in  his  admirable  work  entitled  "  On 
Disorders  of  the  Cerebral  Circulation,"  &c.,  1846.  The  following  ex- 
periments which  he  first  made  are  so  decisive  of  the  question  that  I  can- 
not help  quoting  them  in  full: — 

"  On  the  llth  of  January,  1843,1  killed  two  full-grown  rabbits.  The 
one  (A.)  by  opening  the  jugular  vein  and  carotid  artery  on  one  side  of 
the  throat ;  the  other  (B)  was  strangled.  Each  animal  died  violently 
convulsed.  A  ligature  was  drawn  tightly  round  the  throat  of  the  rabbit  (A) 
immediately  it  expired,  to  prevent  any  further  escape  of  blood  from 
the  vessels  of  the  head.  The  rabbits  were  allowed  to  remain  twenty- 
four  hours  on  a  table  resting  on  their  sides.  While  the  blood  was  flow- 
ing from  the  rabbit  (A),  the  conjunctiva  was  observed  to  become  pallid, 
and  the  eyeballs  to  shrink  within  the  sockets.  Upon  the  examination 
of  the  head  of  the  rabbit,  the  integuments  and  muscles  appeared  blanched 
and  exsanguine.  Upon  removing  the  upper  portions  of  the  cranium,  the 
membranes  of  the  brain  were  found  pallid,  and  scarcely  the  trace  of  a 
blood-vessel  was  to  be  detected  on  the  surface  of  the  brain.  The  longi- 
tudinal and  lateral  sinuses  were  nearly  empty  of  blood,  and  their  course 
was  not  denoted  by  any  color  of  blood.  Upon  making  sections  of  the 
brain,  the  interior  appeared  equally  exsanguine. 

u  Soon  after  the  cord  was  drawn  tight  round  the  throat  of  the  rabbit  (B), 
the  conjunctiva  became  congested,  the  eyeballs  turgid,  prominent, 
and  even  projecting  beyond  the  margin  of  their  sockets.  The  integu- 
ments and  muscles  of  the  head  were  found  full  of  blood.  Upon  opening 
the  cranium,  the  superficial  vessels  of  the  membranes,  as  well  as  the 
sinuses,  were  full  of  dark  liquid  blood.  The  whole  substance  of  the 
brain  and  its  membranes  appeared  of  a  dark  reddish  hue,  as  if  stained 
by  extravasated  blood. 

u  The  contrast  between  the  two  brains  on  the  point  of  vascularity, 
both  on  the  surface  and  in  the  interior,  was  most  striking.  In  the  one, 
scarcely  a  trace  of  blood-vessel  was  to  be  seen  ;  in  the  other,  every  ves- 
sel was  turgid  with  blood.  It  seems  hardly  necessary  to  bring  forward 
further  evidence  to  prove  that  death  by  hemorrhage  has  a  most  decided 
effect  in  depleting  the  vessels  and  reducing  the  quantity  of  blood  within 
as  well  as  upon  the  outside  of  the  cranium. 

u  I  have,  however,  repeated  the  experiments  with  similar  results.  In 
fairness  to  Dr.  Kellie,  I  should  state  that  I  have  attended  at  the  slaugh- 
tering of  sheep  by  butchers,  and  find  the  brains  of  those  animals  much 
less  depleted  than  the  brains  of  rabbits  which  have  died  by  haemorrhage. 
But  the  sheep  did  not  die  from  simple  loss  of  blood,  but  partly  from  the 
division  of  the  pneumogastric  nerves  and  cervical  portion  of  the  spinal 
cord.  These  lesions  no  doubt  influenced  the  appearances. 

*'  Hence  it  is  not  a  fallacy,  as  some  suppose,  that  bleeding  diminishes 
the  actual  quantity  of  blood  in  the  cerebral  vessels.  By  abstraction  of 
blood  we  not  only  diminish  the  momentum,  of  blood  in  the  cerebral 


272  HUMAN    BRAIN. 

arteries  and  the  quantity  supplied  to  the  brain  in  a  given  time,  but  we 
actually  diminish  the  quantity  of  blood  in  those  vessels.  Whether  the 
vacated  place  is  replaced  by  serum  or  resiliency  of  the  cerebral  sub- 
stance under  diminished  pressure,  is  another  question,  into  which  I  do 
not  now  enter." 

Dr.  Burrows  also  made  experiments  to  decide  whether  position  could 
affect  the  condition  of  the  vessels  within  the  skull  ;  for  Dr.  Kellie  had 
asserted  that  the  quantity  of  blood  in  the  cerebral  substance  is  not  affected 
by  posture,  and  details  experiments  in  order  to  prove  it. 

Dr.  Burrows  says,  "  On  the  28th  of  December,  1842,  two  full-grown 
rabbits  were  killed  by  prussic  acid,  and,  while  their  hearts  were  still 
pulsating,  the  one  (c)  was  suspended  by  the  ears,  the  other  (D)  by  the 
hind  legs.  They  were  left  suspended  for  twenty-four  hours  ;  and,  before 
they  were  taken  down  for  examination,  a  tight  ligature  was  placed  round 
the  throat  of  each  rabbit,  to  prevent,  as  effectually  as  was  possible,  any 
further  flow  of  blood  to  or  from  the  head,  after  they  were  removed  from 
their  respective  positions. 

"  In  the  rabbit  (c)  the  whole  of  the  external  parts  of  the  head,  the 
ears,  the  eyeballs,  &c.,  were  pallid  and  flaccid  ;  the  muscles  of  the  scalp 
and  bones  of  the  cranium  were  also  remarkably  exsanguined.  Upon 
opening  the  cranium,  the  membranes  and  substance  of  the  brain  were 
pallid,  the  sinuses  and  other  vessels  were  exsanguined  ;  anaemic  beyond 
my  expectation. 

"In  the  rabbit  (D)  the  external  parts  of  the  head,  the  ears,  eyeballs, 
&c.,  were  turgid,  livid,  and  congested.  The  muscles  and  bones  of  the 
cranium  were  of  a  dark  hue,  and  gorged  with  blood,  which  at  some 
parts  appeared  extravasated.  Upon  opening  the  cranium,  the  mem- 
branes and  vessels  were  dark  and  turgid  with  fluid  blood  ;  the  super- 
ficial veins  were  prominent,  the  longitudinal  and  lateral  sinuses  were 
gorged  with  dark  blood  ;  there  was  staining  of  the  tissues,  if  not  extra- 
vasation of  blood  into  the  membranes.  The  substance  of  the  brain  was 
uniformly  dark,  and  congested  to  a  remarkable  extent." 

"  Dr.  Kellie  asserts,  but  I  think  his  experiments  do  not  support  him, 
that  the  contrast  in  the  appearances  within  the  heads  of  the  two  animals 
was  but  trifling.  In  my  analogous  experiments  the  contrast  was  most 
striking.  In  the  one  was  to  be  seen  a  most  complete  state  of  anemia 
of  the  internal  as  well  as  external  parts  of  the  cranium  ;  in  the  other  a 
most  intense  hyperaBtnia  or  congestion  of  the  same  parts ;  and  these 
opposite  conditions  in  the  vascularity  of  the  brain  induced  solely  by 
posture  and  the  gravitation  of  the  blood." 

"  If  the  cranium  were  the  perfect  sphere,  as  taught  by  Monro,  and 
ass  subsequently  maintained  by  Abercrombie  and  other  distinguished 
writers  on  the  pathology  of  the  brain,  these  effects  on  its  circulation 
(which  I  have  now  exhibited)  ought  not  to  have  resulted  from  the  force 
of  gravity  on  the  blood  in  the  cerebral  vessels." 

When  Dr.  Burrows  first  promulgated  his  opinions  on  this  subject,  he 
was  obliged  to  combat  the  authority  of  Dr.  Watson,  among  other  men 
of  note.  It  is,  therefore,  satisfactory  to  find  this  excellent  physician  now 
giving  in  his  allegiance  to  these  views.  Indeed,  it  may  be  asserted 


ANEMIC    AFFECTIONS.  273 

that  they  are  now  admitted  by  nearly  all  men  as  established  principles 
in  physiology. 

Jincemic  Affections. — During  the  last  twenty  years,  much  has  been  done 
in  cerebral  pathology,  but  in  no  section  of  it  has  so  much  progress  been 
made  as  in  the  anaemic  affections.  At  one  time,  coma  was  considered 
an  unerring  sign  of  pressure  on  the  brain,  and  delirium  an  equally  cer- 
tain indication  of  inflammatory  mischief;  but  it  is  now  well  known  that 
both  may  arise  from  anaemia,  either  local  or  general. 

The  occurrence  of  serious  symptoms  from  a  diminished  supply  of 
blood  to  the  brain  is  not  universally  admitted,  but  it  is  still  a  matter  of 
dispute  with  some,  whether  these  symptoms  are  occasioned  by  diminished 
pressure  on  the  brain,  or  by  a  smaller  quantity  of  blood  within  the  cere- 
bral capillary  system. 

Dr.  Burrows,  in  the  lectures  already  referred  to,  says  that  he  is  inclined 
to  the  opinion  that  some  of  the  most  remarkable  symptoms  arise  rather 
from  insufficient  vascular  pressure  than  from  an  insufficient  quantity  of 
blood  in  the  substance  of  the  brain.  With  all  due  deference  to  this  ad- 
mirable observer,  I  am  inclined  to  an  opposite  opinion.  We  know  that 
the  function  of  all  other  organs,  uninfluenced  by  pressure,  may  be 
excited  by  a  flow  of  blood  into  them,  or  their  function  may  be  arrested 
by  any  stoppage  in  their  supplies.  Take  the  salivary  glands  or  the  testi- 
cles, as  an  illustration:  mental  emotions  will  both  excite  and  arrest  their 
secretions;  and  I  believe  that  the  brain  would  be  similarly  affected,  and 
to  the  same  extent  as  now,  even  if  that  organ  were  not  enclosed  in  a 
spherical  box,  and  supported  on  all  sides  by  the  cerebro-spinal  fluid. 

The  effect  upon  the  sensoriurn,  of  suddenly  cutting  off'  the  supply  of 
blood  to  the  brain,  is  strikingly  exhibited  in  the  familiar  instance  of 
syncope,  whether  induced  by  loss  of  blood  or  mental  emotion.  Now  it 
appears  to  me  contrary  to  all  analogy  that  the  function  of  an  organ  like 
the  brain  (clearly  as  dependent  as  any  other  organ  in  the  body  on  the 
blood  for  its  power,  or  why  should  it  receive  so  very  large  a  proportion 
of  the  whole  circulating  quantity  ?)  should  be  arrested  by  a  mere  change 
in  its  physical  condition.  The  maintenance  of  such  a  doctrine  appears 
to  me  to  partake  of  the  old  leaven,  which  Dr.  Burrows  has  so  admirably 
upset. 

Sir  Astley  Cooper,  by  his  experiments  with  ligatures  on  the  carotid 
and  vertebral  arteries  of  dogs,  showed  the  dependence  of  the  brain  on 
its  supply  of  blood  for  the  performance  of  its  functions.  The  first  effect 
of  pressure  on  the  carotid  arteries  was  to  produce  a  state  of  partial  in- 
sensibility: if  the  pressure  was  continued,  then  the  animal  lost  apparently 
all  consciousness.  By  pressing  on  the  vertebrals  as  well  as  the  carotids, 
life  was  very  soon  extinguished  ;  the  respiratory  centres  receiving  their 
supply  of  blood  from  the  vertebral  arteries. 

In  the  human  being,  the  surgeon  has  occasionally  an  opportunity  of 
observing  the  effect  upon  the  brain  of  cutting  off  a  portion  of  its  supply 
of  blood  by  a  ligature  on  the  carotid  artery.  It  is  true  that  sometimes 
a  ligature  is  thus  applied,  and  no  sensible  impression  produced  upon  the 
sensorium,  but  more  frequently  there  is  an  immediate,  though  it  may 
be  a  temporary,  effect  produced.  In  other  cases,  the  remote  conse- 
quences are  serious.  Dr.  Norman  Chevers  has  published,  in  the  Medical 
18 


274  HUMAN    BRAIN. 

Gazette,  vol.  xxxvi.  p.  1140,  October  31,  1846,  an  admirable  summary 
of  the  cases  in  which  these  vessels  have  been  tied,  and  he  has  exposed 
the  danger  to  which  the  brain  is  subjected  by  this  proceeding,  showing 
that  the  danger  of  the  operation  is  not  confined  to  its  performance.  The 
whole  paper  is  worthy  of  perusal  —  but  I  must  confine  myself  to  some 
of  his  deductions.  He  says,  that  though  by  far  the  larger  proportion  of 
those  in  whom  the  primitive  carotid  artery  on  one  side  is  obliterated, 
recover,  a  considerable  number  become  hemiplegic,  and  perish  from 
disease  of  that  hemisphere  of  the  brain.  The  conclusion  that  oblitera- 
tion of  one  carotid  artery  is  never  liable  to  be  followed  by  impairment 
of  the  cerebral  functions,  must  therefore  be  discarded. 

"(1.)  —  The  form  of  disease  found  in  the  brain  after  death  in  several 
cases  related  above,"  says  Dr.  Chevers,  "was  of  a  kind  which  is  gene- 
rally considered  to  depend  upon  local  anaemia,  not  upon  congestion. 

44  In  some  of  these  instances,  signs  of  deficient  supply  of  blood  in  the 
side  of  the  brain  to  which  the  obstructed  artery  passed,  were  strikingly 
apparent. 

41  The  parts  of  the  cerebral  substance  which  were  principally  involved 
in  disease,  were  those  supplied  by  the  chief  branches  of  the  obstructed 
vessel. 

44  Obliteration  of  the  internal  jugular  vein  was  not  observed. 

44  (2.)  —  There  were  not  remarked  any  morbid  appearances  to  indicate 
that  inflammation  had  been  conveyed  backwards  along  the  nerve  to  the 
brain.  The  part  from  which  the  par  vagum  arises  is  not  shown  to  have 
been  involved  in  the  disease.  That  cerebral  disease  may  be  established 
in  these  cases  quite  independently  of  implication  of  either  the  vein  or 
the  nerve,  is  further  proved  by  the  facts  that  the  paralysis  has  been  known 
to  occur  almost  immediately  after  the  artery  has  become  obliterated, 
before  inflammation  could  be  possibly  established  in  the  surrounding 
parts:  and  that  organic  lesions  of  the  brain  present  themselves  in  cases 
where  the  vessel  has  become  gradually  obliterated  by  processes  which 
are  confined  to  its  interior,  and  do  not  at  all  involve  adjacent  structures; 
that  although  persons  in  whom  the  carotid  is  tied  may  suffer  from  slight 
cerebral  symptoms,  and  yet  perfectly  recover,  those  who  become  com- 
pletely hemiplegic  have  barely  a  chance  of  surviving." 

Dr.  Chevers  sums  up  with  this  excellent  practical  observation:  — 
44  The  facts  adduced  in  this  paper,  it  is  submitted,  prove  that  the  danger 
of  cerebral  disorganization  should  have  its  weight  in  the  consideration 
of  cases  where  it  is  proposed  to  secure  the  common  carotid  artery,  not 
indeed  as  rendering  at  all  doubtful  the  propriety  of  the  operation  in  the 
majority  of  the  cases  in  which  it  is  at  present  had  recourse  to,  but  as 
strongly  discountenancing  it  in  nearly  all  instances  where  the  disease 
for  which  it  is  employed  does  not  positively  threaten  the  patient's  exist- 
ence, and  in  every  case  where  other  means  of  treatment  can  be  em- 
ployed." 

Dr.  Burrows,  whose  opinion  on  all  practical  subjects  is  of  the  high- 
est value,  suggests  the  application  of  a  ligature  to  the  carotid  artery  in 
some  cerebral  affections.  He  says,*  "In  violent  and  hopeless  cases  of 


*  P.  78,  op.  cit. 


DELIRIUM   TREMENS.  275 

epilepsy,  and  some  kindred  maladies  which  are  characterized  by  extreme 
cerebral  congestion,  it  appears  to  me  that,  other  remedies  failing,  this 
operation  may  be  fairly  resorted  to.  I  am  aware  of  the  responsibility  of 
advocating  a  remedy  attended  with  risk  to  life;  but  are  not  all  our  best 
remedies  most  violent  poisons  in  the  hands  of  the  unskillful?"  I  quite 
concur  with  Dr.  Burrows  in  this  opinion,  and  more  particularly  as  the 
operation  has  been  successfully  performed  for  epilepsy — as  related  fur- 
ther on.  x 

Surgical  operations  and  accidents  are  not  the  only  agents  which  pro- 
duce an  anaemia  of  the  brain,  local  or  general. 

The  balance  of  the  circulation  may  be  disturbed  by  various  causes, 
but  there  is  none  so  frequently  observed  as  that  arising  from  the  intem- 
perate use  of  stimulating  drinks. 

Their  primary  effect  is  to  excite  the  heart's  action  to  unnatural  exer- 
tion;  all  the  organs  feel  this,  but  the  brain  more  than  the  rest:  after  a 
storm  comes  a  calm.  The  intervals  between  the  use  of  these  stimuli 
are  the  calms;  but  unlike  the  calms  of  Nature's  hand,  they  are  states 
of  fearful  depression.  When  these  intervals  are  long  continued,  they 
are  not  merely  states  of  depression,  but  states  of  delirium  ;  and  this 
leads  us  to  the  consideration  of  that  frightful,  and,  if  it  were  not  for  the 
feelings  of  pity  which  arise  from  the  contemplation  of  a  human  being 
degraded  below  the  level  of  the  brute,  we  might  add,  disgusting  and 
horrible  malady,  delirium  tremens.  Delirium  ebriosorum  I  regard  as  a 
distinct  disease,  an  hypersemic  affection,  as  will  be  explained  a  little  fur- 
ther on. 

Delirium  Tremens. — I  believe  that  we  are  justified  in  classing  delirium 
tremens  tinder  the  head  of  anaemic  affections  of  the  brain.  It  is  true, 
that  our  pathological  records  of  this  disease  are  very  scanty;  but  in  all 
the  cases  which  I  have  had  the  opportunity  of  examining  after  death,  I 
have  invariably  found  the  hemispherical  ganglion,  or  cortical  substance, 
pale  and  bloodless;  the  venous  canals  were  generally  full;  and  occa- 
sionally the  arachnoid  thickened,  as  if  it  had  been  the  subject  of  chronic 
inflammation.  It  is  curious  that  so  well  as  the  treatment  of  delirium 
tremens  is  now  understood,  it  is  comparatively  only  a  few  years  since 
it  was  first  described  in  print.  The  late  Dr.  Thomas  Sutton,  of  Green- 
wich, first  gave  it  its  present  title,  and  distinguished  it  from  phrenitis. 
He  says,*  "Delirium  tremens,  and  likewise  the  treatment,  which  will 
be  pointed  out  as  we  proceed,  are  known  to  some  professional  men  to  a 
certain  extent;  but  to  many  they  are  wholly  unknown:  and  the  disease 
has  not  yet  taken  a  station  in  medical  writings.  Dr.  Wm.  Saunders,  late 
physician  to  Guy's  Hospital,  and  for  many  years  lecturer  on  medicine 
at  that  hospital,  whose  opinion  I  had  the  advantage  of  obtaining  on  this 
tract,  considered  the  assertions  in  this  paragraph  to  be  perfectly  correct; 
but  stated  to  me,  that  he  had  mentioned  the  disease  alluded  to  in  his 
lectures  for  many  years,  and  had  been  in  the  habit  of  noticing  and  dis- 
tinguishing it  from  phrenitis  during  forty  years  of  his  practice.  So  far 
as  my  observations  and  inquiries  have  gone  on  this  point,  its  treatment 

*  Tract  on  Delirium  Tremens,  by  Thomas  Sutton,  M.I).,  of  the  Royal  College  of  Physi- 
cians, late  Physician  to  the  Forces,  and  Consulting  Physician  to  the  Kent  General  Dispensary. 
1813,  p.  3. 


276  HUMAN    BRAIN, 

is  acknowledged  by  only  a  few,  who  have  not  collected  any  very  arr.ple 
information  on  the  subject."  The  Dr.  does  not  add  to  our  knowledge 
of  the  pathology  of  the  disease. 

Dr.  Copland,  whose  article  on  this  subject,  like  all  contained  in  his 
admirable  Encyclopaedia,  is  copious  and  erudite,  merely  says,  "  The 
appearances  on  dissection  have  furnished  only  negative  information  as 
to  the  nature  of  the  disease."  He  speaks  of  "  slight  opacity  of  the 
arachnoid,  especially  at  the  base,  a  little  injection  of  the  pia  mater,  a 
little  fluid  in  the  ventricles,"  but  not  one  word  about  the  condition  of 
the  cortical  substance  of  the  brain. 

Dr.  Blake*  says,  "  When  this  disease  terminates  fatally,  it  does  not 
seem  to  me  to  be  owing  to  venous  congestion,  as  the  late  much-to-be- 
lamented  Dr.  Armstrong  asserted  in  his  valuable  work,  or  to  inflamma- 
tion of  the  brain,  as  Dr.  Clutterbuck  mentions  in  his  lectures  in  the 
Lancet,  vol.  ii.  p.  376.  I  would  ascribe  it  to  serous  effusion  within 
the  cranium — every  post-mortem  that  I  have  since  witnessed  in  cases  of 
pure  delirium  tremens,  tended  to  confirm  me  in  these  sentiments." 

This  author  makes  an  excellent  practical  observation,  to  the  correct- 
ness of  which  T  can  add  my  testimony,  and  which  bears  out  my  view 
of  the  anaemic  character  of  this  disease.  The  stimulus  of  light,  or  in- 
deed of  any  excitant,  seems  of  advantage  in  delirium  tremens;  but  not 
so  in  the  commencement  of  mania:  its  symptoms  are  invariably  exas- 
perated by  such  influence. 

Many  authors  have  divided  delirium  tremens  into  two  kinds,  but,  as 
I  have  long  thought  and  taught,  erroneously.  They  have,  in  fact,  con- 
founded that  delirium,  delirium  ebriosorum,  which  may  be  excited  in 
any  individual  by  the  use  of  stimulants,  with  the  true  delirium  tremens, 
which  is  alone  produced  by  the  sudden  withdrawal  of  a  long-continued 
use  of  them.  The  one  depends  on  a  congested  state,  the  other  on  an 
anaemic  condition,  of  the  hemispherical  ganglion.  Entertaining  these 
opinions,  I  was  much  pleased  to  find  it  thus  treated  by  Dr.  Blake. f 
Correct  views  on  this  subject  are  essential  to  a  right  understanding  for 
practical  purposes,  of  many  other  diseases  of  the  nervous  system.  I 
suspect  many  forms  of  Hysteria  are  dependent  on  a  similar  anaemic  con- 
dition of  the  brain,  though  the  cause  producing  it  is  so  widely  different. 

Dr.  Blake  regards  them  as  distinct  and  opposite  diseases,  the  one 
being  the  immediate  consequence  of  intemperance,  the  other  arising 
from  the  sudden  cessation  of  accustomed  intemperate  stimulation — the 
one  requiring  the  cautious  use  of  depletion,  the  other  the  administration 
of  stimuli — the  one  belonging  to  the  class  phlegmasiee,  the  other  to  that 
of  neuroses.  In  illustration  of  the  distinction  of  the  delirium  which  im- 
mediately follows  indulgence  to  excess  in  spirituous  liquors,  and  that 
which  does  not  come  on  until  after  a  cessation  of  intemperate  habits, 
he  relates  a  case  of  a  man  who  was  an  habitual  tippler,  and  whenever 
he  exceeded  his  usual  allowance,  which  was  tolerably  often,  he  was 
attacked  with  furious  delirium,  and  which,  if  not  cautiously  treated, 

*   A  practical  Essay  on  the  disease  generally  known  under  the  denomination  of  Delirium 
Tremens,  &c.,  by  Andrew  Blake,  M.  D.,  M.  R.C.  S.,  &c.,  18-10,  p.  58. 
f  P.  04.  op.  cit. 


DELIRIUM    TREMENS.  277 

was  followed  by  a  consequent  stage  of  exhaustion,  and,  in  due  time,  by 
all  the  stages  of  delirium  tremens. 

This  peculiar  idiosyncrasy  of  constitution,  by  presenting  both  diseases 
successively  in  the  one  subject,  serves  to  point  out  clearly  the  difference 
which  exists  between  the  delirium  consequent  upon  the  immediate 
effects  of  spirits,  or  other  diffusible  stimuli,  and  that  which  succeeds  in 
one,  two,  three,  or  more  days,  as  the  consequence  of  suddenly  desisting 
from  the  habitual  abuse  of  any  stimuli. 

In  the  cases  of  delirium  tremens  which  we  have  in  the  surgical  wards 
of  the  hospital,  the  disease  generally  comes  on  in  patients  who  have  met 
with  some  severe  injury,  such  as  fracture  of  one  or  more  of  the  extre- 
mities, injuries  of  the  head,  &c.,  and  whose  habits  are  extremely  intem- 
perate. Many  of  these  miserable  drunkards  are  in  the  habit  of  swal- 
lowing more  than  a  gallon  of  beer  in  the  day,  with  a  certain  amount  of 
gin  to  carry  it  off  by  the  kidneys.  On  their  admission  into  the  hospital, 
of  course  the  enormous  supplies  are  cut  off',  though  we  generally  ascer- 
tain what  are  the  usual  habits  of  our  patients,  and  give  them  a  little 
extra  to  the  ordinary  house  allowance.  But  a  pint  of  beer  extra  is  a 
mere  drop  in  the  ocean  compared  to  their  usual  quantity,  and  in  a  few 
days  we  often  observe  a  slight  tremor  of  the  tongue  when  protruded. 
There  is  a  wildness  about  the  eye,  an  unnatural  quickness  of  manner 
when  answering  our  questions.  The  sister  of  the  ward  tells  us  that 
during  our  absence  he  is  very  busy  pulling  the  bed  clothes,  perhaps 
rolling  up  his  upper  sheet.  The  tongue  is  not  unusually  dry  or  furred, 
as  in  phrenitis  ;  the  skin  is  bathed  in  sweat ;  the  pulse  is  quick  and 
irregular,  both  in  force  and  frequency.  Now  if  we  do  not  take  the  hint 
of  the  storm  which  is  threatened  by  these  premonitory  symptoms,  we 
find  our  patient  in  a  state  of  raving  delirium  in  the  course  of  a  very 
few  hours,  and  woe  to  the  fracture. 

Dr.  Watson,  whose  description  of  all  disease  is  so  graphic  and  so 
correct,  and  who  has  seen  it  more  frequently  than  I  have  had  the  oppor- 
tunity of  doing,  unconnected  with  a  confinement  to  bed  by  local  injuries, 
says,  "  The  delirium  you  will  generally  find  to  be,  not  a  fierce  or  mis- 
chievous delirium,  but  a  busy  delirium  ;  he  does  whatever  you  desire 
him  to  do,  but  he  does  it  in  a  hurried  manner,  with  a  sort  of  anxiety  to 
perform  it  properly.  During  the  approach  of  the  malady,  while  he  is 
yet  able  to  go  about,  he  manifests  great  impatience  of  any  interference, 
or  advice,  or  assistance  in  his  ordinary  duties,  which  he  sets  about  in  a 
bustling  and  blundering  manner.  His  loquacity  is  extreme,  and  he  re- 
fers to  matters  that  are  not  present  before  him  ;  he  is  not  altogether  in- 
attentive to  the  objects  and  proceedings  that  are  going  on  around  him, 
but  his  mind  wanders  away  to  other  subjects.  There  is  an  odd  mixture 
of  the  real  and  the  ideal  in  his  thoughts  and  language.  Sometimes  he 
is  very  suspicious  that  those  who  are  about  him  intend  him  some  injury  ; 
or  that  he  is  surrounded  by  enemies.  You  will  find  also  that  he  does 
not  sleep,  that  he  has  not  slept  perhaps  for  several  nights,  but  been  rest- 
less and  rambling;  and  you  will  generally  learn  that  he  has  been  habi- 
tually intemperate,  or  subject  to  some  great  source  of  care,  or  anxiety, 
or  excitement:  and  in  many  cases  he  has  been  recently,  somehow  or 
other,  debarred  from  his  customary  stimulus.  In  addition  to  these  points 


278  HUMAN    BRAIN. 

in  his  history,  you  will  frequently  be  told  that  having  been  unwell,  first 
he  has  been  kept  upon  low  diet,  and  then,  as  the  delirium  came  on,  he 
has  been  freely  bled,  and  that  he  has  been  none  the  better,  but  com- 
monly the  worse  for  the  bleeding.  When  you  gather  such  particulars 
as  these  from  his  friends  (for  upon  his  own  statements  you  cannot  place 
any  reliance),  and  when  you  find  the  delirium  to  have  the  character  I 
have  been  attempting  to  describe,  and  especially  when  there  has  been 
obstinate  watchfulness,  and  the  tongue  is  moist,  and  the  skin  is  sweating, 
you  may  be  pretty  certain  that  your  paiient  is  affected,  not  with  inflam- 
mation of  the  brain,  but  with  delirium  tremens  ;  and  Jhat  if  you  bleed 
him  further  you  will  make  him  worse."  Sometimes  the  pathological 
condition  which  excites  delirium  ebriosorum  is  an  inflammatory  action 
of  a  low  character  occurring  in  a  constitution  much  shattered  by  long- 
continued  debauchery.  In  these  cases  it  is  necessary  to  support  the 
system  with  the  accustomed  fermented  liquors,  and  employ  local  coun- 
ter-irritants to  the  head,  with  diuretics,  to  prevent  serous  effusion.  The 
following  history  illustrates  this  class  of  cases : — 

Case  1. — Conl?on  Johnson,  aet.  47,  waterman  on  cab-stand,  countenance  bloated,  admitted 
into  Georges  Ward,  under  my  care,  January  12th,  1847,  with  simple  fracture  of  the  thigh, 
about  the  middle  third.  It  was  very  loose,  and  he  complained  of  much  pain.  He  appeared 
as  if  he  had  been  drinking,  and  his  face  was  flushed  and  skin  moist.  Pupils  dilated.  Ap- 
peared inclined  to  sleep,  and  does  not  answer  questions  readily.  His  breath  was  very  foul. 
When  in  bed  his  teeth  chattered  from  cold,  and  so  he  continued  for  some  time. 

Was  put  up  in  splints  for  the  night. 

Jan.  13th.  Has  passed  a  restless  night,  and  complains  of  much  pain.  Pulse  quick  and 
full.  Skin  moist,  but  he  says  he  is  very  cold.  Tongue  and  breath  foul.  Restless.  Put  up 
in  the  straight  splints — great  difficulty  in  doing  so,  owing  to  his  drawing  the  limb  up.  Says 
he  has  been  used  to  drink  freely.  Mr.  Green  saw  him,  and  ordered  Opii  gr.  j.  statim.  To? 
wards  night  he  was  quiet  for  a  time  after  the  opium,  but  at  8  P.M.  wanted  to  get  out  of  bed, 
and  was  noisy  but  not  violent.  Vespere.  Mr.  Whitfield  ordered  him,  Sol.  Morph.  Mur. 
Tt^xx.  Ammon.  Carb.  gr.  v.  ex.  Mist.  Camph.  6''"  Gin  ^iv.  Pulv.  Rhei.  c.  Hydr.  ^j-  stfit- 

14th.  Is  no  better.  Passed  evacuations  and  urine  in  bed  this  morning.  Dozes  off  occa- 
sionally, awakes,  and  is  restless,  and  then  dozes  again  for  a  time.  Answers  questions  when 
roused.  He  removed  all  the  apparatus  from  his  thigh. 

15th.  Much  the  same.  Removes  his  apparatus,  and  the  handcuffs  were  put  on  him. 
I  saw  him  lor  the  first  time  to-day.  The  symptoms  were  very  obscure;  there  was  more 
coma  and  less  tremor  than  we  generally  meet  with  in  delirium  tremens.  But  the  cold  sur- 
face, sleeplessness,  contracted  pupils,  and  weak  pulse,  determined  me  to  give  him  porter;  at 
the  same  time  I  thought  it  safe  to  add  some  tinctura  Lyttre  to  his  medicine,  in  order  to 
excite  the  action  of  the  kidneys  and  avert  serous  cerebral  effusion,  of  which  there  was 
some  threatening.  Porter,  2  pints;  Tinct.  LytUe  Tt^xv.  e.  Mist.  Pupils  contracted.  Gets 
no  continued  rest. 

16th.  No  better;  4  pints  of  porter. 

17th.  Is  decidedly  belter  for  the  extra  porter;  but  as  he  has  diarrhoea,  and  passes  motions 
in  bed,  I  feel  obliged  to  omit  the  porter,  and  order  Trse.  Opii  TT^x.  Mist.  Creue  Co.  ^j.  Gtis- 
Brandy  ^iv.  daily. 

18th.  A  little  better.  Has  not  passed  evacuations  since.  Is  restless  towards  night.  Pulse 
slower. 

20th.  His  hands  having  been  unfastened,  he  undid  all  the  apparatus  during  the  night. 

22d.  Sol.  Morph.  Mur  Tt^xl.  e.  Mist.  blis-     Continues  in  much  the  same  state. 

26th.  No  better;  but  with  rather  more  tendency  to  coma.  Hyd.  c.  Cretae  gr.  ij  o.n.  Trse. 
Opii  (>''••  horis — Empl.  Lyttoe  pone  aures. 

27th.  Apparatus  put  up  once  more. 

28th.  Is  better  lor  the  blister.  Has  been  quiet  since  yesterday,  and  answers  questions 
more  rationally. 

30th.  Still  better.  Answers  questions  perfectly — remembers  the  circumstances  of  the 
accident — but  not  his  pulling  the  splints  off.  Does  not  pass  evacuations  in  bed.  Porter  ilbfs. 

Feb.  1st.  As  bad  as  ever.  Removed  all  the  splints  again,  but  answers  questions,  and  de- 
clares lie  does  not  meddle  with  the  apparatus,  but  that  the  other  patieats  do.  In  this  state 


DELIRIUM    TREMENS.  279 

he  continued  until  February  10th;  his  hands  muffled  night  and  day.  Takes  his  drink  and 
asks  for  more.  He  was  tried  for  a  day  without  the  gin,  but  soon  became  worse  for  that. 
Empl.  Lyttae  p.  aur. 

16th.  Rather  better.  One  hand  let  loose,  when  he  immediately  removed  the  splints ; 
talks  rationally  except  at  night,  when  he  calls  out  on  people  whom  he  has  seen  in  the  day, 
and  sometimes  is  very  noisy.  Pulse  natural.  Evacuations  not  passed  in  bed. 

20th.  Put  up  in  pasteboard  splints  to-day.  The  stimulants  were  continued,  and  he  gra- 
dually recovered,  but  with  weakened  intellects. 

Judging  from  the  cases  of  delirium  ebriosorum,  which  are  even  now 
occasionally  published  in  the  medical  periodicals  as  cases  of  delirium 
tremens,  I  am  afraid  that  this  distinction  is  not  sufficiently  attended  to. 
The  diagnosis  is  often  very  difficult,  but  I  have  almost  always  found  that 
when  large  doses  of  opium  fail  in  producing  sleep,  we  ought  to  con- 
sider that  the  case  is  one  of  hyperaBmia,  and  not  anaemia,  and  if  we 
change  the  treatment,  relieving  the  congestion  of  the  brain,  sleep  soon 
follows.  It  is  better  to  avoid  the  use  of  all  blood-letting  if  possible,  and 
never  to  abstract  it  except  locally.  Leeches  and  the  cupping-glass  are 
the  best  agents.  A  warrn-bath  for  the  whole  body,  and  cold  to  the  head, 
either  by  means  of  a  stream  of  cold  water  or  pounded  ice,  prove  much 
better  narcotics  than  all  the  varied  forms  of  opium,  in  delirium  ebriosorum. 
If  these  means  do  succeed,  their  success  establishes  the  nature  of  the 
case,  and  ought  to  guide  our  future  treatment,  as  explained  further  on 
in  the  section  on  chronic  meningitis.  These  cases  are  often  very  obsti- 
nate, and  require  great  patience  on  the  part  of  both  patient  and  surgeon. 
They  often  ultimately  terminate  with  more  or  less  mental  debility.  The 
last  case  of  this  kind  which  I  had  under  my  care  was  a  retired  naval 
surgeon  ;  he  nearly  recovered  from  the  corporeal  disorder,  but  I  fear 
that  his  mental  energy  is  so  weakened,  that  he  will  return  again  to  the 
fatal  source  of  his  disease. 

It  is  impossible  to  give  in  words,  all  that  distinguishes  these  two  dis- 
eases ;  they  must  be  seen  frequently  to  be  appreciated.  But  the  follow- 
ing will  assist  in  their  diagnosis.  The  head  and  skin  generally  is  cool 
and  moist  in  delirium  tremens,  dry  and  hot  in  delirium  ebriosorum.  The 
pupil  varies  in  both  according  to  the  stage  :  in  the  early  stage  of  both 
it  is  generally  contracted,  in  the  latter  stage  dilated.  The  conjunctiva 
injected  and  red  in  delirium  ebriosorum  ;  the  reverse  in  delirium  tremens. 
The  mental  derangement  in  the  former  is  more  allied  to  an  exalted,  ex- 
cited state  of  intellect ;  in  the  latter  it  approaches  fatuity  and  depression. 
The  tongue  is  generally  pale  and  furred  in  delirium  tremens,  sometimes 
unnaturally  clean  and  red  ;  in  delirium  ebriosorum  is  usually  dry,  and 
sometimes  brown,  but  this  is  no  certain  guide.  The  pulse  is  most  un- 
certain, for  as  all  inflammatory  affections  of  the  brain  are  depressing  in 
their  effects  on  the  heart's  action,  so  do  we  find  that  the  pulse  is  not  hard 
and  wiry  in  the  hyperaeraic  affection,  which,  however,  never  amounts 
to  one  acutely  inflammatory.  Still,  on  the  whole,  there  is  less  power  in 
the  beat  of  the  artery,  and  that  more  varied  in  delirium  tremens  than  in 
delirium  ebriosorum. 

The  danger  attending  an  error  in  diagnosis  in  such  cases  is  evident, 
for  if  we  omit  to  recognize  the  inflammation  of  delirium  ebriosorum, 
only  a  few  days  need  elapse  to  render  such  inflammation  fatal ;  and  even 
in  those  cases  in  which  all  the  signs  of  delirium  tremens  are  so  clearly 


280  HUMAN    BRAIN. 

present  that  we  cannot  mistake  them,  we  have  to  bear  in  mind  that 
though  delirium  tremens  is  not  an  inflammatory  disease,  that  the  exces- 
sive and  constant  use  of  stimulating  liquors  does  predispose  the  mem- 
branes of  the  brain  to  inflammation,  and  that  the  two  diseases  frequently 
run  one  ijito  the  other. 

The  plan  of  treatment  which  I  have  found  on  the  whole  most  success- 
ful in  true  delirium  tremens,  is  to  give  the  stimulus  which  the  patient 
prefers  from  being  most  accustomed  to:  this  is  usually  porter  and  gin, 
in  the  hospitals ;  brandy  or  wine,  or  both  together  in  private  practice. 
And  revolting  as  it  is  to  our  feelings  as  moral  bein'gs  to  pour  in  the  very 
poisons  which,  by  their  habitual  use,  have  reduced  the  man  to  the  level 
of  the  brute,  still,  as  medical  men,  it  is  our  duty  to  preserve  life  by  those 
means  which  we  know  are  capable  of  doing  so. 

Often  have  I  been  obliged  to  go  on  increasing  the  quantity  of  porter 
from  one  pint  up  to  four  or  even  five  ;  and  gin  up  to  twelve  and  sixteen 
ounces.  I  always  combine  with  it  opium  and  ammonia.  I  much  prefer 
the  tincture  of  opium  to  any  other  preparation,  as  being  more  certain 
and  more  rapid  in  its  action.  I  give  thirty  drops  with  a  drachm  of  the 
spiritus.  am.  aromat.  in  camphor  mixture  every  four  hours,  and  a  drachm 
of  the  tincture  at  night,  to  be  repeated  if  it  does  not  produce  sleep  in 
two  hours. 

If  there  is  much  irritability  of  stomach,  I  then  give  it  in  a  state  of 
effervescence. 

I  have  had  no  experience  of  anodyne  enemata,  as  recommended  by 
Dupuytren,  but  I  should  not  hesitate  to  employ  them,  if  the  oral  exhibi- 
tion of  opium  failed. 

As  soon  as  the  stomach  will  retain  any  food,  it  must  be  given.  Patients 
^will  often  take  soups  and  broths  before  solids  ;  but  whatever  is  given 
should  be  highly  nutritive. 

Generally  speaking,  I  find  this  plan  successful.  Where  it  has  failed, 
it  has  generally  done  so  because  it  has  not  been  adopted  early  enough, 
and  the  stimulus  has  not  been  given  in  sufficiently  large  quantities,  or 
the  patient  has  been  an  old  man,  whose  constitution  had  been  worn  out 
by  long-continued  intemperance  and  repeated  attacks  of  this  awful  com- 
plaint. 

Dr.  Blake  says,*  and  I  agree  with  him,  "The  state  of  the  pulse, 
though  not  always  an  infallible  guide  in  disease,  has  been  to  me  a  com- 
paratively sure  one  in  this  complaint,  as  when  its  frequency  did  not  ex- 
ceed one  hundred  strokes  in  the  minute,  I  looked  on  the  patient,  generally 
speaking,  as  safe;  but  on  the  contrary,  when,  from  its  rapidity,  and  the 
tremor  of  the  hands,  it  could  scarcely  be  counted,  I  considered  him  in 
imminent  danger." 

The  cases  of  delirium  tremens  which  are  the  most  difficult  to  diagnose 
and  prescribe  for,  are  those  which  accompany  injuries  of  the  skull  oc- 
curring to  persons  of  intemperate  habits,  such  as  brewers'  servants,  many 
of  whom  we  have  admitted  into  St.  Thomas's  Hospital. 

The  late  Mr.  Tyrrell,  from  whose  practical  skill  I  derived  much  valu- 
able knowledge,  used  to  recommend  the  use  of  diffusible  stimulus,  such 

*  Op.  cit 


ANEMIC    COMA.  281 

as  ammonia,  in  the  first  instance,  as  a  feeler  in  doubtful  cases,  as  the 
effect  was  evanescent,  even  if  it  should  prove  injurious.  The  pulse  is 
often  an  uncertain  criterion,  but  it  will  be  generally  found  that  a  pulse 
which  alters  much,  either  in  rapidity  or  in  power,  is  not  one  that  indicates 
inflammatory  action.  It  is  generally  a  sign  of  weakness.  Mr.  Tyrrell 
used  to  relate  a  case  which  occurred  in  his  practice  in  illustration  of  this 
view,  and  the  danger  attending  an  erroneous  diagnosis. 

Case  2. — A  patient  was  admitted  having  received  a  severe  blow  on  the  head  which  ren- 
dered him  quite  insensible.  Reaction  took  place  very  slowly;  Mr.  T.  first  gave  him  am- 
monia, and  afterwards  a  small  quantity  of  porter  :  he  improved  slightly.  Tn  the  evening  he 
was  seen  by  another  surgeon,  who  took  a  different  view  of  the  case,  arid  ordered  him  to  be 
bled  from  the  arm.  He  died  the  following  morning,  with  serous  effusion  on  the  brain,  but 
no  signs  whatever  of  inflammation  or  congestion. 

An&mic  Coma. — We  have  seen  that  delirium  may  arise  from  an  ane- 
mic condition  of  the  brain,  and  we  shall  next  observe  that  a  state  of  in- 
sensibility may  be  produced  by  similar  causes. 

I  believe  that  if  cerebral  anaemia  be  allowed  to  continue  for  a  long 
period,  it  will  occasionally  terminate  in  hydrocephalus,  and  also  in  the 
white  form  of  ramollissement. 

We  will  first  consider  anaemic  hydrocephalus,  with  its  effect,  anaemic 
coma,  for  I  believe  that  there  are  twro  forms  of  hydrocephalus,  the  one 
anaemic,  the  other  inflammatory,  as  well  as  two  forms  of  ramollisse- 
ment. 

Dr.  Marshall  Hall  was  one  of  the  first  to  point  out  the  resemblance 
which  exists  between  a  comatose  condition  arising  from  exhaustion,  and 
that  which  is  occasioned  by  inflammation  and  effusion.  The  affection 
which  Dr.  Hall  described,  arises  principally  in  infants,  but  it  is  not 
confined  to  them.  He  calls  it  "  an  hydrencephaloid  affection  of  infants 
arising  from  exhaustion." 

Dr.  Hall  has  observed  this  affection  generally  as  a  consequence  of  con- 
tinued diarrhosa,  produced  either  by  bad  diet  or  long-continued  use  of 
purgative  medicines,  or  as  a  consequence  of  blood-letting.  He  divides 
the  affection  into  two  stages,  "the  first  that  of  irritability,  the  second 
that  of  torpor ;  in  the  former  there  appears  to  be  a  feeble  attempt  at  re- 
action, in  the  latter  the  nervous  powers  appear  to  be  more  prostrate." 
He  thus  describes  the  signs  of  complaint:  "The  infant  becomes  irrita- 
ble, restless  and  feverish,  the  face  flushed,  the  surface  hot,  and  the 
pulse  frequent;  there  is  an  undue  sensitiveness  of  the  nerves,  and  the 
little  patient  starts  on  being  touched,  or  from  any  sudden  noise;  there 
are  sighing,  moaning,  during  sleep,  and  screaming;  the  bowels  are  fla- 
tulent and  loose,  and  the  evacuations  are  mucous  and  disordered.  If, 
through  an  erroneous  notion  as  to  the  nature  of  this  affection,  nourish- 
ment and  cordials  be  not  given ;  or,  if  the  diarrhea  continue,  either 
spontaneously  or  from  the  administration  of  medicine,  the  exhaustion 
which  ensues  is  apt  to  lead  to  a  very  different  train  of  symptoms.  The 
countenance  becomes  pale,  and  the  cheeks  cool  or  cold ;  the  eyelids  are 
half  closed,  the  eyes  are  fixed,  and  unattracted  by  any  object  placed 
before  them,  the  pupils  unmoved  on  the  approach  of  light;  the  breath- 
ing, from  being  quick,  becomes  irregular  and  affected  by  sighs;  the  yoice 
becomes  husky;  and  there  is  sometimes  a  husky,  teazing  cough;  and 


282  HUMAN    BRAIN. 

eventually  the  strength  of  the  little  patient  has  been  subdued,  and  the 
vascular  system  exhausted,  by  abstraction  of  blood." 

Dr.  Hall  considers  that  this  affection  is  to  be  distinguished  from  true 
hydrocephalus  principally  "  by  observing  the  condition  of  the  counte- 
nance, and  by  tracing  the  history  and  causes  of  the  affection." 

Dr.  Abercrombie  observes,*  "In  the  last  stages  of  diseases  of  exhaus- 
tion, patients  frequently  fall  into  a  state  resembling  coma,  a  considerable 
time  before  death,  and  while  the  pulse  can  still  be  felt  distinctly;  I  have 
many  times  seen  children  lie  for  a  day  or  two  in  this  kind  of  stupor,  and 
recover  under  the  use  of  wine  and  nourishment.  It  is  often  scarcely 
to  be  distinguished  from  the  coma  which  accompanies  diseases  of  the 
brain.  It  attacks  them  after  some  continuance  of  exhausting  diseases, 
such  as  tedious  or  neglected  diarrhea,  and  the  patients  lie  in  a  state  of 
insensibility,  the  pupils  dilated,  the  eyes  open  and  insensible,  the  face 
pale,  and  the  pulse  feeble.  It  may  continue  for  a  day  or  two,  and  ter- 
minate favorably,  or  it  may  prove  fatal.  This  affection  seems  to  corre- 
spond with  the  apoplexia  ex  inanitione  of  the  older  writers.  It  differs 
from  syncope  by  coming  on  gradually,  and  in  continuing  a  considerable 
time,  perhaps  a  day  or  two;  and  it  is  not,  like  syncope,  induced  by  sud- 
den and  temporary  causes,  but  by  causes  of  gradual  exhaustion  going 
on  for  a  considerable  time.  It  differs  from  mere  exhaustion,  in  the 
complete  abolition  of  sense  and  motion,  while  the  pulse  can  be  felt  dis- 
tinctly, and  is,  in  some  cases,  of  considerable  strength.  I  have  seen  in 
adults  the  same  affection,  though  perhaps  it  is  more  uncommon  than  in 
children."  In  a  letter  which  Dr.  Hall  received  from  Dr.  Abercrombie, 
that  gentleman  observes,  "  The  state  of  infants  which  I  have  referred 
to,  is  a  state  of  pure  coma,  scarcely  distinguishable,  at  first  sight,  from 
the  perfect  stupor  of  the  very  last  stage  of  hydrocephalus,  the  child  lying 
with  the  eyes  open,  or  half  open,  the  pupils  dilated,  the  face  pale.  It 
is  difficult  to  describe  distinctly  the  appearance,  but  it  is  one  which  con- 
veys the  expression  of  coma,  rather  than  of  sinking  ;  and  I  remember 
the  first  time  I  met  with  the  affection,  the  circumstance  which  arrested 
my  attention,  and  led  me  to  suppose  the  disease  was  not  hydrocephalus, 
the  state  somewhat  different  from  coma,  was  finding  on  further  inquiry, 
that  it  came  on  after  diarrhoaa,  and  not  with  any  symptom  indicating  an 
affection  of  the  head.  The  child  recovered  under  the  use  of  wine  and 
nourishment." 

u  The  remedies  for  this  affection,"  says  Dr.  Hall,  u  are  such  as  will 
check  this  diarrhoea,  and  afterwards  regulate  the  bowels  and  restore  and 
sustain  the  strength  of  the  little  patient.  With  the  first  object,  it  may  be 
necessary  to  give  the  tinctura  opii  and  chalk,  and  afterwards  the  pilula 
hydrargyri,  rhubarb  and  magnesia;  with  the  second,  sal  volatile,  but 
especially  brandy,  and  proper  nourishment  are  to  be  given  according  to 
circumstances.  But  in  this,  as  in  so  many  cases  of  infantile  disorders, 
the  young  milk  of  a  young  ami  healthy  nurse  is  the  best  remedy  of  all  ; 
in  the  absence  of  which,  asses'  milk  may  be  tried,  but  certainly  not  with 
the  same  confident  hope  of  benefit." 

"  Five  or  ten  drops  of  the  sal  volatile  may  be  given  every  three  or 

*  P.  72, 76. 


ANEMIC    COMA.  283 

four  hours,  and  twice  or  thrice  in  the  interval  five  or  ten  drops  of  brandy 
may  be  given  in  arrow-root  done  in  water.  As  the  diarrhoea  and  appear- 
ances of  exhaustion  subside,  these  remedies  are  to  be  subtracted,  the 
bowels  are  to  be  watched  and  regulated,  and  the  strength  is  to  be  con- 
tinually sustained  by  the  nurse's  or  asses'  milk.  The  brandy  has  some- 
times appeared  to  induce  pain — sal  volatile  is  then  to  be  substituted  for 
it ;  a  dose  of  magnesia  has  also  appeared  to  do  good.  For  the  state  of 
irritability,  the  warm-bath  is  a  remedy  of  great  efficacy.  For  the  coma, 
a  small  blister  or  sinapism  should  be  applied  to  the  nape  of  the  neck. 
A  state  of  exhaustion  of  the  general  system,  as  I  have  observed  else- 
where, by  no  means  precludes  the  possibility  of  real  congestion  of  the 
brain.  It  rather  implies  it.  In  extreme  cases  these  are  not  only  the 
symptoms  of  cerebral  congestion  during  life,  but  effusion  of  serum  into 
the  ventricles  of  the  brain  is  found  on  examination  after  death.  In  every 
case  the  extremities  are  to  be  kept  warm  by  flannel,  and  the  circulation 
should  be  promoted  in  them  by  assiduous  frictions.  It  is  of  the  utmost 
importance  carefully  to  avoid  putting  the  little  patient  into  the  erect 
posture.  A  free  current  of  air  is  also  a  restorative  of  the  greatest  effi- 
cacy." 

Dr.  M.  Hall  follows  up  this  account  with  some  excellent  cases  very 
illustrative  of  his  views  ;  he  also  quotes  the  following  observations  of 
Dr.  Gooch,  which,  like  all  that  this  excellent  practitioner  ever  penned, 
are  worthy  of  attention  : — 

"  Case  3. — A  little  girl,  about  two  years  old,  small  of  her  age,  very  delicate,  was  taken  ill 
with  the  symptoms  which  I  have  above  described.  She  lay  dozing,  languid,  with  a  cold, 
skin,  and  a  pulse  rather  weak,  but  not  much  quicker  than  natural.  She  had  no  disposition 
to  take  nourishment.  Her  sister  having  died  only  a  week  before  of  an  illness  which  began 
exactly  in  the  same  way,  and  some  doubts  having  been  entertained  by  the  medical  attendant 
of  the  propriety  of  the  treatment,  leeches  were  withheld,  but  the  child  not  being  better  at 
the  end  of  two  days,  the  parents,  naturally  anxious  about  their  only  surviving  child,  consulted 
another  practitioner.  The  case  was  immediately  decided  to  be  one  of  cerebral  congestion, 
and  three  leeches  were  ordered  to  be  applied  to  the  head. 

"As  the  nurse  was  going  to  apply  them,  and  during  the  absence  of  the  medical  attendants, 
a  friend  called  in  who  had  been  educated  for  physic,  and  who  had  great  influence  with  the 
family;  he  saw  the  child,  said  that  the  doctors  were  not  sufficiently  active,  and  advised  the 
number  of  leeches  to  be  doubled.  Six,  therefore,  were  applied;  they  bled  copiously:  but 
when  the  medical  attendants  assembled  in  the  evening,  they  found  the  aspect  of  the  case 
totally  altered,  and  that  for  the  worse ;  the  child  was  deadly  pale,  it  had  scarcely  any  pulse, 
its  skin  was  cold,  the  pupils  were  dilated  and  motionless  when  light  was  allowed  to  fall  on 
them,  and  when  a  watch  was  held  to  its  eyes  it  seemed  not  to  see;  there  was  no  squinting. 
Did  this  state  of  vision  depend  on  the  pressure  of  a  fluid  effused  into  the  brain  since  the 
bleeding,  and  during  this  exhausted  and  feeble  state  of  circulation,  or  did  it  depend  on  the 
circulation  of  the  brain  being  too  languid  to  support  the  sensibility  of  the  retina?  It  is  well 
known  that  large  losses  of  blood  enfeeble  vision.  I  saw  a  striking  instance  of  this  in  a  lady 
who  flooded  to  death.  When  I  entered  the  chamber  she  had  no  pulse,  and  she  was  tossing 
about  in  that  restless  state  which  is  so  fatal  a  sign  in  these  terrific  cases.  She  could  still 
speak,  asked  whether  I  was  come  (she  knew  I  had  been  sent  for),  and  said,  'Am  I  in  any 
danger?  how  dark  the  room  is!  I  can't  see.'  The  shutters  were  open,  the  blind  up,  and  the 
light  from  the  window,  facing  the  bed,  fell  strong  on  her  face.  I  had  the  curiosity  to  lift  the 
lid  and  observe  the  state  of  the  eye;  the  pupil  was  completely  dilated,  and  perfectly  motion- 
less, though  the  light  fell  strong  on  it.  Who  can  doubt  that  here  the  insensibility  of  the  re- 
tina depended  on  the  deficiency  of  its  circulation  ? — But  to  return  to  the  little  patient.  The 
next  day  she  had  vomited  her  food  several  times;  it  was,  therefore,  directed  that  she  should 
take  no  other  nutriment  than  a  dessertspoonful  of  asses'  milk  every  hour,  and  this  was 
strictly  obeyed,  and  continued  for  several  days.  The  child  wasted,  her  features  grew  sharp, 
and  every  now  and  then  she  looked  fretful,  and  uttered  a  faint  squeaking  cry;  the  eyeballs 
became  sunk  in  the  socket,  like  those  of  a  corpse  that  had  been  dead  a  month  ;  the  skin 
continued  cool,  and  often  cold,  and  the  pulse  weak,  tremulous,  and  sometimes  scarcely  to  be 


HUMAN    BRAIN. 

felt.  Under  this  regimen,  and  in  this  way,  she  continued  to  go  on  for  several  days.  At 
times  she  revived  a  little,  so  as  to  induce  those  who  prescribed  this  treatment  to  believe  con- 
fidently that  she  would  recover ;  and  she  clearly  regained  her  sight,  for  if  a  watch  was  held 
up  to  her  she  would  follow  it  with  her  eyes.  She  lived  longer  than  I  expected — a  full 
week,  and  then  died  with  the  symptoms  of  exhaustion,  not  with  those  of  oppressed  brain. 
The  head  was  opened  by  a  surgeon  accustomed  to  anatomical  examinations,  and  nothing 
was  found  but  a  little  more  serum  than  is  usual  in  the  ventricles. 

"  If  the  reader  has  perused  the  foregoing  case  attentively,  and  has  re- 
flected on  it,  he  will,  of  course,  draw  his  own  inferences.  I  can  draw 
no  other  than  these:  that  the  heaviness  of  head  and  drowsiness  which 
were  attributed  to  congestion  in  the  brain,  really  depended  on  a  defi- 
ciency of  nervous  energy;  that  the  bleeding  and  scanty  diet  aggravated 
this  state,  and  insured  the  death  of  the  child  ;  also  that  the  state  of  the 
eye  which  so  speedily  followed  the  loss  of  blood,  and  which  resembled 
that  occasioned  by  effusion,  did,  in  reality,  depend  on  a  deficiency  in 
the  circulation  of  the  brain — a  fact  of  considerable  curiosity  and  import- 
ance. 

"  I  will  now  relate  a  case  similar  in  the  symptoms,  but  very  different 
in  the  treatment  and  result. 

"  Case  4. — I  was  going  out  of  town  one  afternoon,  last  summer,  when  a  gentleman  drove 
up  to  my  door  in  a  coach,  and  entreated  me  to  go  and  see  bis  child,  which  he  said  had  some- 
thing the  matter  with  its  head,  and  that  the  medical  gentleman  of  the  family  was  in  the 
house,  just  going  to  apply  leeches.  I  went  with  him  immediately;  and  when  I  entered  the 
nursery,  I  found  a  child  ten  months  old  lying  on  its  nurse's  lap,  exactly  in  the  state  which  I 
have  already  described; — the  same  unwillingness  to  hold  its  head  up,  the  same  drowsiness, 
languor,  absence  of  heat,  and  all  symptoms  of  fever.  The  child  was  not  small  of  its  age,  and 
had  not  been  weak,  but  it  had  been  weaned  about  two  months,  since  which  it  had  never 
thriven.  The  leeches  had  not  been  put  on.  I  took  the  medical  gentleman  into  another 
room,  related  to  him  the  foregoing  case,  and  several  similar  to  it,  which  had  been  treated  in 
the  same  way.  Then  I  related  to  him  a  similar  case,  which  I  had  seen  in  the  neighboring 
square,  which  had  been  treated  with  ammonia  in  decoction  of  bark,  and  good  diet,  which 
had  recovered ;  not  slowly,  so  as  to  make  it  doubtful  whether  the  treatment  was  the  cause 
of  the  recovery,  but  so  speedily,  that  at  the  third  visit  I  took  my  leave.  He  consented  to 
postpone  the  leeches,  and  to  pursue  the  plan  which  I  recommended.  We  directed  the  gruel 
diet  to  be  left  ofl^  and  no  other  to  be  given  than  asses'  milk,  of  which  the  child  was  to  take 
at  least  a  pint  and  a  half,  and  at  most  a  quart,  in  the  twenty-four  hours.  Its  medicine  was 
10  minims  of  the  aromatic  spirit  of  ammonia  in  a  small  draught  every  four  hours.  When 
we  met  the  next  day,  the  appearance  of  the  child  proved  that  our  measures  had  been  right; 
the  nurse  was  walking  about  the  nursery  with  it  upright  in  her  arms.  It  looked  happy  and 
laughing;  the  same  plan  was  continued  another  day;  the  next  day  it  was  so  well  that  I  took 
my  leave,  merely  directing  the  ammonia  to  be  given  at  longer  intervals,  and  thus  gradually 
withdrawn ;  the  asses'  milk  to  be  continued,  which  kept  the  bowels  sufficiently  open,  with- 
out aperient  medicine. 

"  So  inveterate  is  the  disposition  to  attribute  drowsiness  in  children 
to  congestion  of  the  brain,  and  to  treat  it  so,  that  I  have  seen  an  infant, 
four  months  old,  half  dead  from  the  diarrhoea  produced  by  artificial  food, 
and  capable  of  being  saved  only  by  cordials,  aromatics,  and  a  breast  of 
milk  ;  but  because  it  lay  dozing  on  its  nurse's  lap,  two  leeches  had  been 
put  on  the  temples,  and  this  by  a  practitioner  of  more  than  average 
sense  and  knowledge.  I  took  off  the  leeches,  stopped  the  bleeding  of 
the  bites,  and  attempted  nothing  but  to  restrain  the  diarrhoea,  and  get  in 
plenty  of  nature's  nutriment,  and  as  I  succeeded  in  this  the  drowsiness 
went  off  and  the  child  revived.  If  it  could  have  reasoned  and  spoken, 
it  would  have  told  this  practitioner  how  wrong  he  was;  any  one,,  who 
from  long  defect  in  the  organs  of  nutrition  is  reduced  so  that  he  has  neither 
flesh  on  his  body,  nor  blood  in  his  veins,  well  knows  what  it  is  to  lay 


ANEMIC    COMA.  285 

down  his  head  and  doze  away  half  the  day  without  any  congestion  or  in- 
flammation of  the  brain.  This  error,  although  I  have  specified  it  only  in  a 
particular  complaint  of  children,  may  be  observed  in  our  notions  and  treat- 
ment of  other  diseases,  and  at  other  periods  of  life.  If  a  woman  has  a  pro- 
fuse hemorrhage  after  delivery,  she  will  probably  have  a  distressing  head- 
ache, with  throbbing  in  the  head,  noises  in  the  ears,  a  colorless  complexion, 
and  a  quick,  weak,  often  thrilling  pulse,  all  which  symptoms  are  greatly 
increased  by  any  exertion.  I  have  seen  this  state  treated  in  various  ways, 
by  small  opiates,  gentle  aperients,  and  unstimulating  nourishment,  with 
no  relief.  I  have  seen  blood  taken  away  from  the  head,  and  it  has 
afforded  relief  for  a  few  hours,  but  then  the  headache,  throbbing,  and 
noises,  have  returned  worse  than  ever;  the  truth  is,  that  this  is  the 
acute  state  of  what  in  a, minor  degree,  and  in  a  more  chronic  form,  oc- 
curs in  chlorosis,  by  which  I  mean  pale-faced  amenorrhoea,  whether  at 
puberty  or  in  after-life.  It  may  be  called  acute  chlorosis,  and,  like  that 
disease,  is  best  cured  by  steel,  given  at  first  in  small  doses,  gradually  in- 
creased, merely  obviating  constipation  by  aloetic  aperients." 

My  esteemed  friend  and  colleague,  Dr.  Risdon  Bennett,  in  his  admira- 
ble work  on  Hydrocephalus,  advocates  the  doctrine,  that  this  disease 
assumes  very  distinct  forms  ;  and  that  though  it  undoubtedly  does  arise 
in  some  instances  from  inflammation,  in  others  it  arises  from  an  opposite 
condition.  He  says,*  u  There  can  be  no  difficulty  in  admitting  that  the 
physical  alterations  of  softening  and  serous  effusion  may  be  induced  by 
functional  and  organic  changes,  very  different  from  inflammation  or  any 
allied  morbid  action."  He  considers  that  in  by  far  the  largest  class  of 
cases,  the  disease  is  essentially  the  result  of  scrofulous  action,  and  may 
or  may  not  be  attended  by  the  signs  of  inflammation. 

The  comatose  condition  which  we  see  occasionally  following  a  severe 
attack  of  erysipelas  of  the  head  in  a  debilitated  constitution,  comes  into 
this  category  of  anaBinic  affections  of  the  brain.  It  is  difficult  to  say 
whether  this  condition  of  the  brain  is  the  result  of  that  general  depres- 
sion which  is  both  cause  and  effect  in  the  erysipelas  of  London,  or 
whether  it  can  be  attributed  to  a  derivation  of  blood  to  the  surface.  We 
all  know  that  in  hypersemia  of  the  brain  we  can  relieve  our  patients  by 
determining  the  blood  to  the  surface.  It  is  therefore  possible,  that  this 
morbid  cutaneous  determination  of  blood  has  the  effect  of  diminishing 
the  supply  to  the  capillaries  of  the  brain  as  effectually  as  our  artificial 
measures.  In  a  practical  point  of  view  there  is  nothing  more  important 
to  the  surgeon  than  a  knowledge  of  the  fact  that  a  rambling,  incoherent 
manner  in  the  day,  with  a  restless  delirium  at  night,  is  no  proof  of  the 
existence  of  inflammatory  action  in  the  brain.  The  following  case  may 
be  selected  from  many  in  illustration  of  this  view  of  the  subject: — 

Case  5. — In  the  month  of  January,  1846, 1  removed  a  small  tumor  from  over  the  parotid 
gland  in  a  gentleman  aged  25. 

He  imprudently  exposed  himself  to  cold  after  the  operation,  notwithstanding  my  strong 
injunctions  to  keep  his  room,  for  fear  of  erysipelas  being  excited.  My  fears  were  realized, 
and  a  severe  attack  was  the  result.  My  friend  Dr.  Munk  attended  the  case  with  me.  The 
erysipelatous  inflammation  attacked  the  wound  on  the  fifth  day — but  I  will  give  the  case  in 
his  words : — 


The  Cause?,  Nature,  Diagnosis,  and  Treatment  of  Acute  Hydrocephalus,  1848,  p.  147. 


286  HUMAN    BRAIN. 

"The  patient  went  on  satisfactorily  for  some  days;  but  on  Saturday,  January  31st,  he  felt 
unwell,  and  erysipelas  attacked  the  wound,  which,  at  that  time,  however,  had  nearly  healed. 
The  redness  and  swelling  extended  somewhat  over  the  cheek,  and  along  the  neck,  and  an 
incision  was  made  through  the  swollen  parts.  Port  wine,  decoction  of  bark,  and  small 
quantities  of  infusion  of  senna,  were  given  at  intervals. 

"  I  saw  the  case  in  consultation  with  Mr.  Solly,  on  Tuesday,  February  3d.  The  inflam- 
mation had  then  extended  over  the  whole  of  one  side  of  the  face,  and  the  rUht  eye  was 
completely  closed.  The  affected  parts  were  of  a  dusky  red  hue;  the  pulse  120;  the  bowels 
purged;  and  there  was  some  griping.  The  patient  was  manifestly  anxious  about  himself, 
and  wandered  slightly  at  times,  although  answering  every  question  with  perfect  accuracy. 
He  was  ordered  eight  ounces  of  port  wine,  and  seven  drachms  of  decoction  of  bark;  one 
drachm  of  the  compound  tincture  of  bark,  and  four  grains  of  the  sesqui  carbonate  of  am- 
monia, every  four  hours. 

"The  following  day  (Wednesday,  February  4th),  he  appeared  much  the  same;  the  erysi- 
pelas, however,  extending,  now  implicated  the  forehead,  though  not  encroaching  upon  the 
hairy  scalp. 

•'  On  Thursday,  February  5th,  he  was,  in  every  respect,  decidedly  worse ;  the  left  side  of 
the  face  and  ear  had  now  become  affected,  the  disease,  however,  subsiding  in  the  parts  first 
attacked.  The  forehead  was  much  swollen,  tense,  and  of  a  dusky-red;  the  pulse  still  120, 
but  decidedly  weaker.  He  wandered  considerably,  but  still  replied  to  questions  with  tolera- 
ble accuracy,  though  rambling  off  again  immediately.  During  the  night  he  had  been  vio- 
lently delirious;  had  got  out  of  bed  in  spite  of  his  attendants;  and  was  with  difficulty  re- 
strained. His  forehead  was  punctured  by  Mr.  Solly  in  several  places  with  the  point  of  a 
lancet,  and  a  large  bread  and-water  poultice  applied.  A  few  drops  of  blood  only  exuded. 
He  was  ordered  to  have  two  ounces  of  port  wine  every  two  hours,  and  to  continue  his  mix- 
ture as  before.  This  was  at  mid-day.  About  midnight  we  found  him  slightly  improved, 
quiet,  rational,  and  his  pulse,  if  anything,  stronger  an  1  less  frequent.  The  wine  and  bark 
had  been  given  regularly,  and  he  had  taken  considerable  quantities  of  jelly  and  strong  beef- 
tea. 

"  On  the  ensuing  day  (Friday,  Feb.  6th),  at  half  past  four  o'clock  P.M.,  we  found  him 
again  very  decidedly  changed,  for  the  worse.  The  erysipelatous  inflammation  had  not  ex- 
tended, but  his  tongue  had  become  dry,  dark -brown,  and  fissured;  his  pulse  130,  and  much 
weaker:  the  whole  surface  was  below  the  natural  temperature,  and  the  extremities  were 
decidedly  cold.  He  laid  in  a  heavy,  semi-comatose  condition,  and  was  altogether  incapable 
of  replying  to  our  inquiries.  His  breathing  was  becoming  difficult  and  infrequent.  Two 
ounces  of  port  wine  were  ordered  every  hour,  and  to  each  dose  of  the  mixture,  which  was 
now  to  be  given  at  intervals  of  two  hours,  there  was  added  one  drachm  of  the  compound 
spirit  of  sulphuric  ether.  A  turpentine  enema  was  also  employed,  at  the  suggestion  of  our 
patient's  friend,  Mr.  Bristowe,  of  Camberwell.  who,  throughout,  watched  the  case  with  much 
anxiety,  and  favored  us  with  his  assistance  and  advice  during  the  most  alarming  stages  of 
the  disease.  At  six  o'clock  P.M.,  our  patient  was  seen  by  his  neighbor,  Mr.  Henry,  of  the 
Commercial-Road.  He  was  then  sinking  rapidly.  The  pulse  had  risen  to  150,  or  upwards, 
find  had  become  weak  and  thready:  the  respirations  took  place  at  longer  interval*,  and  were 
more  laborious:  his  legs  were  icy  cold.  Mr.  Henry  poured  a  full  glass  of  brandy  down  the 
throat,  and  repeated  it  at  intervals  of  half  an  hour  or  an  hour;  beef-tea  and  jelly  were  also 
given  freely.  By  these  means  the  symptoms  of  sinking  were  for  the  time  arrested.  At  half 
past  ten  o'clock  P.M.,  I  found  him  perfectly  rational,  his  tongue  moist,  and  the  dark  brown 
coating  gone;  the  pulse  reduced  in  frequency,  from  150  to  1 12  or  1 18,  and  having,  in  great 
measure,  recovered  its  strength  and  volume;  his  breathing  was  now  natural  and  easy,  and 
the  body  and  extremities  were  warm.  The  brandy  was  ordered  to  be  continued  every  hour. 

"  Feb.  7th. — Our  patient  went  on  well  during  the  early  portion  of  the  night,  but  at  four 
o'clock  A.M.  symptoms  of  sinking  again  appeared;  his  pulse  became  rapid  and  weak;  the 
surface  cold,  and  the  respirations  labored.  Drachm-doses  of  sulphuric  ether  were  now  given 
with  the  brandy,  and  under  their  joint  influence  he  again  rallied.  Since  this,  he  has  been 
progressing  favorably.  His  pulse  is  now  (ten  o'clock  P.M.)  under  100;  skin  warm  and  moist; 
tongue  clean  amb moist.  He  is  now  perfectly  rational,  arid  has  slept  quietly  and  comfort- 
ably at  intervals;  the  inflammation  has  not  extended,  and  desquamation  has  commenced; 
the  bowels  have  not  been  relieved  since  last  evening;  but  he  feels  an  inclination  to  go  to 
stool.  He  has  up  to  this  time  continued,  and  is  still  to  continue,  the  brandy,  beef-tea,  &c.,  at 
short  intervals. 

"8th. — Noon:  the  swelling  of  the  face  has  now  much  diminished,  and  desquamation  is 
taking  place  over  the  whole  of  the  affected  parts;  pulse  below  ninety,  with  more  power, 
but  unequal,  and  with  a  long  intermission  from  time  to  time.  This  intermission,  however, 
is  less  marked  at  the  heart  than  in  the  radial  artery;  tongue  moist;  feet  comfortably  warm  ; 
owing  to  the  diminution  of  the  swelling  he  can  now  open  both  eyes ;  he  has  passed  one 


ANAEMIC    COMA.  „  287 

healthy  evacuation.  About  four  o'clock  this  morning  symptoms  of  sinking  again  returned; 
he  breathed  with  much  effort,  and  the  feet  and  legs  became  cold,  a  state  which  shortly, 
however,  disappeared  under  the  freer  use  of  stimuli.  He  was  now  ordered  to  take  the 
brandy  in  smaller  quantities,  and  to  have  two  grains  of  quinine  in  decoction  of  bark  every 
four  hours. 

"On  Monday,  Feb.  9th,  I  found  him  in  every  respect  improved:  he  was  quite  collected 
and  comfortable;  had  slept  well  during  the  night ;  his  pulse  had  more  power,  and  was  under 
ninety  in  the  minute  :  the  skin  was  warm  and  moist.  Convalescence  was  from  this  period 
steadily  progressive.  Suppuration  of  both  eyelids  took  place,  and  the  pus  was  evacuated 
by  the  lancet.  He  left  town  on  the  26th  of  February,  and  returned  about  the  end  of  March 
perfectly  well. 

''  Here  is  an  instance  of  erysipelas  treated  by  what  some  would  perhaps  characterize  as  an 
undue  and  lavish  administration  of  stimulants;  but  I  feel  fully  convinced  (arid  I  believe  the 
conviction  is  equally  strong  in  the  minds  of  those  who  watched  the  case)  that  nothing  short  of 
the  quantities  given  would  have  been  competent  to  bring  about  a  favorable  issue.  I  am  no 
advocate  for  large  doses  of  medicines  in  ordinary  cases.  On  the  contrary,  I  am  inclined  to 
believe  that  the  tendency  of  medical  opinion  and  practice  is.  at  the  present  time,  in  favor  of 
larger  doses  than  the  absolute  requirements  of  disease  render  necessary;  and  I  am  quite 
sure  that  benefit  would  accrue  to  the  patient,  in  most  cases,  by  a  diminution  in  this  respect. 
It  must,  however,  be  remembered,  that  cases  do  every  now  and  then  occur  of  such  extreme 
severity  as  to  render  ordinary  plans  of  treatment  inefficient.  In  these  we  must  step  out  of 
the  beaten  track,  and  administer  our  remedies  to  an  amount  which,  in  more  ordinary  cases, 
would  be  injurious  and  culpable.  The  case  above  related  is  one  in  point.  I  know  of  no 
instance  of  erysipelas  in  which  so  large  a  quantity  of  stimulants  has  been  necessary:  and  I 
certainly  have  never  met  with  one  in  which  their  effects  were  so  strikingly  and  unequivo- 
cally beneficial. 

"  On  Thursday,  Feb.  5th,  about  mid-day,  the  freer  use  of  wine  was  commenced.  He  took 
two  ounces  every  two  hours,  and  continued  it  till  half  past  four  P.M.  of  the  following  day. 
In  the  four-and  twenty  hours  he  had  thus  taken  twenty-four  ounces  of  wine,  besides  jelly, 
beef  tea,  and  the  bark-and-ammonia  mixture.  At  half  past  four  o'clock,  when  Mr.  fcolly, 
Mr.  Bristowe,  Mr.  Henry  and  1  saw  him,  he  was  sinking,  and  now  two  ounces  of  wine  were 
given  every  hour,  and  a  drachm  of  Hoffman's  anodyne  every  alternate  hour.  Even  this 
quantity  did  not  suffice,  and  at  six  o'clock  Mr.  Henry,  with  a  promptitude  and  decision  to 
which  our  patient,  I  believe,  owes  his  life,  commenced  the  administration  of  brandy.  A 
wineglassful  was  given  every  hour,  and  continued  in  the  same  quantity,  and  at  similar  in- 
tervals, till  Feb.  8th,  at  noon.  During  this  period  of  forty-two  hours,  he  took,  at  the  very 
lowest  computation,  upwards  of  sixty  ounces  of  brandy.  Notwithstanding  the  quantity  ad- 
ministered, neither  the  patient's  pulse  nor  his  nervous  system  was  at  any  time  unduly  ex- 
cited. On  the  contrary,  the  larger  the  quantity  of  brandy  given,  the  stronger  but  less  frequent 
became  the  pulse,  the  stupor  was  diminished,  and  the  delirious  wandering  quieted.  The 
tongue  likewise  became  clean  and  moist.  The  latter  circumstance  was  strikingly  illustrated 
on  Friday,  Feb.  6th.  At  half  past  four  o'clock,  the  tongue  was  dry,  dark-brown,  and  fis- 
sured ;  at  six  o'clock  he  appeared  to  be  dying,  and  now  commenced  the  administration  of 
brandy.  A  wineglassful  was  given  at  intervals  of  less  than  an  hour  At  ten  o'clock 
the  tongue  had  become  moist,  and  the  dark-brown  coating  was  gone.!' 

This  case  requires  little  comment;  it  speaks  for  itself;  and  it  is  not  a 
rare  one  ;  many  such  might  be  brought  forward.  Our  patient  was  on  the 
brink  of  the  grave  ;  his  brain  was  so  disturbed  that  his  intellect  had  fled. 
Brandy  in  quantities  which,  in  a  state  of  health,  would  have  produced 
complete  intoxication  and  insensibility,  restored  his  senses,  removed  his 
fever,  and  saved  his  life.  It  is  indeed  an  interesting  question  to  us, 
what  is  the  positive  state  of  brain  which  accompanies  this  disorder  of 
the  intellect.  I  believe  that  it  is  a  state  of  local  anaemia.  It  is  not 
often  that  we  have  the  opportunity  of  examining  it  in  its  simple,  uncom- 
plicated condition,  as  it  so  frequently  follows  an  inflammatory  state, 
though  the  inflammation  may  have  been  one  of  a  low  or  sub-acute  cha- 
racter. With  the  view  of  ascertaining  the  condition  of  the  brain,  I 
have  always  anxiously  sought  for  every  opportunity  of  examining  the 
brain  of  patients  who  have  died  in  this  state,  and  I  have  generally  found 
it  free  from  all  signs  of  inflammation.  Nevertheless,  though  it  is  true 


288  HUMAN    BRAIN. 

that  in  London,  as  a  general  rule,  erysipelas  is  a  disease  of  debility,  re- 
quiring wine,  brandy,  &c.,  we  must  remember  that  acute  inflammation 
of  the  scalp  will  sometimes  travel  by  continuity  of  tissue  to  the  mem- 
branes of  the  brain,  and  then  prove  rapidly  fatal,  either  by  serous 
effusion  or  by  acute  inflammation  of  the  hemispherical  ganglion.  We 
should  therefore  endeavor,  in  our  constitutional  treatment,  to  steer  a 
middle  course  on  the  onset,  keeping,  as  sailors  say,  your  weather  eye 
open  for  a  storm  from  very  opposite  points  of  the  compass.  A  scruple 
of  rhubarb  and  calomel,  that  is,  five  grains  of  calomel  to  fifteen  of  rhu- 
barb, followed  by  a  senna  draught  in  the  morning,  clears  the  prima  via  and 
fits  the  system  for  either  course,  as  subsequent  events  may  direct.  la 
wounds  of  the  scalp  it  may  be  well  to  remark  that  often  when  the  peri- 
cranium has  been  extensively  separated  from  the  bone,  and  the  edges 
of  the  wound  heal  quickly,  there  is  always  danger  of  subsequent  suppu- 
ration, and  the  surgeon  must  be  on  the  alert  to  make  a  free  opening,  as 
matter  cannot  be  put  up  between  the  tendon  of  the  occipito  frontalis 
and  the  bone  without  the  brain  sympathizing. 

I  remember  inspecting  the  body  of  a  very  fine  young  woman  who 
died  with  erysipelas  of  the  scalp,  and  in  whom  there  was  a  large  col- 
lection of  pus  under  the  back  part  of  the  pericranium,  which  the  medical 
man  failed  to  detect  during  life,  but  which  most  assuredly  must  have 
been  instrumental  in  producing  the  fatal  result,  for  there  was  a  corre- 
sponding inflammation  of  the  membranes  of  the  brain,  though  not  of  an 
active  character  or  great  extent ;  there  was  also  some  serous  effusion. 

A  morbid  condition  of  the  brain  of  an  anaBmic  character  is  often  in- 
duced in  London  by  long-continued  dyspepsia,  with  confinement  in  an 
impure  atmosphere.  One  of  the  worst  cases  of  this  kind  I  ever  saw  was 
the  following: 

Case  G. — A  watch  and  clock  maker,  who  lived  in  the  neighborhood  of  Shoreditch,  con- 
sulted me  in  January.  1840.  He  was  a  cripple,  and  therefore  unable  to  take  much  ex- 
ercise, 38  years  of  age,  unmarried,  spare  habit,  and  lax  fibre.  He  stated  that  he  had  been 
suffering  for  the  last  eight  months  with  a  disorder  in  his  head.  He  described  his  symptoms 
in  the  following  words: — Loss  of  appetite,  confusion,  giddiness  in  the  head,  violent  sickness, 
sleepless  nights,  horrid  dreams,  waking  suddenly  in  a  fright,  noises  in  the  head  and  ears, 
sometimes  like  the  singing  of  a  tea-kettle,  sometimes  like  a  wineglass  or  a  large  rummer 
struck  close  to  the  ear,  sometimes  like  water  thrown  on  a  hot  iron,  or  running  from  a  tap, 
sometimes  like  a  muffled  drum  at  a  distance;  occasionally  on  falling  off  to  sleep,  he  would 
be  awakened  by  a  feeling  as  if  a  sky-rocket  were  shot  through  his  head ;  sometimes  he 
would  be  very  deaf. 

He  suffered  occasionally  from  violent  headaches,  and  black  and  bright  spots  dancing  before 
his  eyes  ;  and  to  sum  up  his  mental  miseries,  he  had  a  constant  dread  of  his  memory  failing 
him.  His  bowels  were  generally  relaxed,  and  he  suffered  frequently  from  pain  in  his 
stomach. 

After  carefully  balancing  all  the  above  symptoms,  formidable  by  themselves,  with  the 
following — a  languid,  weak,  irritable  pulse,  cold  skin,  pale,  flabby  tongue — I  came  to  the 
conclusion,  that  all  his  symptoms  arose  from  anaemia,  occasioned  by  inadequate  assimilation 
of  his  food.  I  treated  him  on  this  view  of  his  case.  All  his  sufferings  were  relieved,  and 
he  was  quite  restored  to  health  in  about  two  months,  by  giving  him  in  the  first  instance 
small  doses  of  blue  pill  at  night  and  a  mild  aperient  in  the  morning,  and  afterwards  light 
bitters  with  rhubarb  and  soda,  and  strict  attention  to  diet. 

I  have  frequently  been  consulted  by  professional  men,  and  others  en- 
gaged in  business  in  London,  who,  suffering  from  London  cachexia, 
have  supposed  that  they  have  some  disease  of  the  brain.  In  one  in- 
stance my  patient  stated  that  he  had  lost  his  memory,  that  he  frequently 


CEREBRAL    ANAEMIA.  289 

would  ring  the  bell  and  forget  before  his  servant  answered  it  what  he 
had  rung  it  for;  he  complained,  also,  of  having  a  sort  of  muzzy  feeling 
in  his  head,  that  he  could  not  read  or  apply  himself  to  anything;  horse 
exercise  was  dreadful  to  him.  He  was  a  long  while  in  getting  well, 
but  it  was  ultimately  effected,  entirely  by  means  of  very  mild  tonics. 

Bakers  are  very  liable  to  these  affections,  owing,  I  suppose,  to  their 
irregular  habits,  sudden  alternations  of  temperature,  and  disturbance  of 
the  natural  hours  of  rest,  &c.  I  do  not  refer  to  the  decidedly  intemperate. 
The  following  brief  abstract  illustrates  my  meaning : — 

Case  7. — Charles  Chadwick,  aet.  23,  biscuit  baker,  pale  complexion,  weak  and  irritable 
pulse,  states,  he  awakes  in  the  middle  of  the  night  with  .a  start,  and  is  afterwards  seized 
with  giddiness  in  the  head,  but  that  he  is  very  much  relieved  by  getting  out  of  bed  and  walk- 
ing about  his  room;  this  returns  two  or  three  times  in  the  same  night.  He  says  that  it  has 
lately  come  on  in  the  day.  His  general  health  is  not  very  good;  has  had  gonorrhoea  for  the 
last  twelve  months,  which  is  getting  a  little  better.  He  is  now  much  depressed  in  spirits. 

This  case  was  treated  entirely  upon  a  tonic  system,  principally  with  quina  ;  he  took  it  for 
some  time,  and  though  the  improvement  was  not  rapid,  he  ultimately  recovered. 

When  these  symptoms  have  lasted  some  time,  they  are  subdued  with 
difficulty,  and  require  care.  It  is  very  necessary  that  the  practitioner 
should  inform  the  sufferer  of  their  obstinacy,  otherwise  he  will  become 
impatient  and  dissatisfied.  In  the  treatment  of  them,  stimulants  are 
prejudicial,  and  the  tonics  must  be  very  mild.  Steel  and  quinine  seldom 
answer  at  first,  and  afterwards  only  in  small  doses.  Strict  diet,  pure  air, 
and  exercise  without  fatigue,  are  more  important  than  medicine.  I  make 
it  an  almost  invariable  rule  to  give  an  active  purgative — calomel,  &c., 
at  night,  haustus  senna  in  the  morning;  and  I  examine  the  evacuation 
before  prescribing  any  other  medicine.  If  the  liver  is  at  fault,  taraxa- 
cum, with  small  doses  of  sulphate  of  magnesia,  and  sulphuric  acid,  will 
be  found  more  beneficial  generally  than  mercury.  This  diseased  con- 
dition cannot  be  removed  by  a  coup  de  main,  and  it  is  not  advisable  to 
say  much  to  your  patients  regarding  its  nature,  for  if  you  convince  them 
that  it  arises  from  debility,  they  think  that  they  have  nothing  to  do  but 
to  eat,  drink,  and  sleep,  and  thus  get  strong,  and  then  they  will  be  well. 
On  the  other  hand,  you  must  relieve  their  minds  of  the  impression,  that 
it  is  allied  to  apoplexy,  and  depends  on  fullness  of  the  head  or  inflam- 
mation of  the  brain,  which  is  generally  their  feeling,  or,  otherwise,  they 
will  be  anxious  to  be  cupped,  leeched,  &c.  If  you  have  sensible  per- 
sons to  deal  with,  you  may  explain  the  real  rationale  of  your  treatment; 
if  not,  you  must  keep  them  in  ignorance  ;  but  especially  guard  against 
dropping  one  word  about  weakness,  for  all  prefer  eating  and  drinking  to 
taking  physic;  and  they  will  think  they  understand  all  about  it,  and, 
throwing  physic  to  the  dogs,  feed  themselves.  Finding  this  fail,  they 
immediately  conclude  that  you  have  mistaken  the  nature  of  their  case, 
go  to  somebody  else,  who  perhaps  orders  a  few  leeches  to  the  head, 
which  sometimes  relieve  for  a  day  or  two,  from  the  reaction  which  takes 
place,  and  this  confirms  their  opinion,  until  they  again  get  worse. 

The  state  of  the  nervous  functions  in  a  chlorotic  female  forms  another 
good  illustration  of  the  effect  of  anaemia  on  the  brain.  It  is  not  neces- 
sary to  detail  symptoms  which  are  familiar  to  all. 

How  instructive  it  is  to  watch  the  gradual  disappearance  of  the  head- 
aches, often  most  violent,  under  a  judiciously  managed  course  of  steel 
19 


290  HUMAN    BRAIN. 

medicine.  After  the  bowels  have  been  freely  opened  and  the  tongue 
clean,  there  is  nothing  equal  to  the  old  steel  mixture  with  the  compound 
decoction  of  aloes  and  aromatip  confection,  with  a  drachm  of  the  spiritus 
inyristici ;  but  the  practitioner  must  not  expect  the  headaches  to  be  re- 
moved immediately. 

I  believe  that  if  cerebral  anaBmia  continues  for  a  long  while,  it  will 
produce  white  softening,  or  one  form  of  ramollissement,  sometimes  in 
connection  with  hydrocephalus,  as  we  have  seen,  sometimes  independent 
of  it.  This  form  of  disorganization  does  not  often  occur  in  the  middle 
period  of  life  ;  it  sometimes  occurs  in  the  infant  and  the  child,  as  a  se- 
quence to  hydrocephalus,  and  in  the  old  man,  from  disease  of  the  arteries, 
or  other  impediments  to  the  circulation  ;  sometimes  in  the  chlorotic  female. 
But  we  must  distinguish  the  two  kinds  of  softening;  there  is  some  dif- 
ference of  opinion  as  to  their  nature  and  origin  ;  I  will  therefore  give  a 
short  detail  of  the  opinions  of  the  best  pathologists  on  its  real  nature. 

The  term  made  use  of  to  distinguish  this  peculiar  disorganization  of 
the  brain,  implies  the  appearance  which  it  presents  to  the  observer:  it 
is,  in  fact,  softening  of  the  substance  of  the  brain,  generally  isolated  in  its 
seat.  By  this  the  observer  distinguishes  it  from  the  firmer  portions  of 
the  brain  which  surround  it,  though,  as  it  sometimes  happens  that  the 
whole  brain  is  softened  and  broken  down  into  a  pulpy  mass,  he  has 
more  difficulty  in  deciding  whether  it  is  truly  a  morbid  appearance,  or 
simply  the  effect  of  decomposition.  The  portion  thus  broken  down  does 
not  necessarily  lose  its  natural  color,  though  frequently  it  becomes 
darker ;  however,  it  never  resembles  pus  either  in  color  or  in  its  disa- 
greeable odor,  so  that  it  ought  never  to  be  confounded  with  suppu- 
ration. 

The  earliest  observations  on  this  peculiar  lesion  of  the  brain  are  to  be 
met  with  -in  the  fifth  Letter  of  Morgagni,  De  Sedibus,  &c.,*  u  which 
treats  of  the  apoplexy  as  arising  neither  from  a  sanguineous  nor  a  serous 
cause;" 

Case  8.— The  patient  whose  case  he  relates  was  in  her  59th  year,  and  was  seized  with  an 
apoplexy,  followed  by  loss  of  speech  and  paralysis,  with  loss  of  sensation  of  the  right  side. 
She  was  not  insensible,  for  "she  gave  of  her  own  accord  the  sound  arm  to  the  physicians  to 
have  her  pulse/elt,"  and  "  she  had  no  difficulty  in  swallowing  fluids,';  but  did  not  live  many 
days  after  her  admission  to  the  hospital. 

Of  the  post-mortem  appearances  I  shall  merely  detail  those  which  illustrate  the  lesion  in 
question;  and, these  I  shall  give  from  Dr.  Alexander's  translation,  in  the  author's  own 
words : 

"But  let  us  now  goon  to  the  head,  for  the  sake  of  which,  principally,  this  dissection  was 
performed.  While  the  skull  was  sawed  through,  a  quantity  of  serum  came  forth ;  and  the 
upper  part  of  it  being  taken  off,  and  the  brain  being  dissected  in  its  natural  situation,  we  first 
observed  that  the  dura  mater  was  thickened.  And  the  vessels  that  ran  through  the  pia 
mater  were  all  distended  with  blood,  as  if  they  had  been  filled  by  injection.  This  blood 
was  such  as  that  of  the  whole  body,  black,  and  not  very  fluid.  And  under  the  same  mem- 
brane, in  the  convolutions  of  the  brain,  was  seen  a  transparent  water,  of  the  same  kind  with 
that  which  was  found  in  the  lateral  ventricles  afterwards ;  yet  the  choroid  plexuses  were 
not  at  all  discolored,  although  they  had  vesicles  upon  them  turgid  with  water,  and  one  of 
these  vesicles  was  equal  even  to  the  bigness  of  a  grape.  This  was  in  the  left  plexus,  which 
being  taken  off,  the  thalamus  nervi  optici  appeared  not  of  the  same  color  as  the  right  thala- 
mus,  but  brown.  As  I  cut  the  brain  into  small  pieces,  I  observed  that  every  other  part  of  it 
was  natural  and  sound;  but  that  the  medullary  substance,  which  was  on  the  external  side 
of  the  left  thalamus,  spoken  of  above,  was  very  soft,  and  liquefied,  and  was  found  to  be  mixed 


*  Translated  by  Dr.  Alexander,  1769,  p.  98,  article  6. 


RAMOLLISSEMENT.  291 

with  a  certain  bloody  fluid,  of  a  color  almost  effete:  so  that  nothing  but  a  disagreeable  smell 
was  wanting  to  make  us  pronounce  it  absolutely  rotten.  The  space  of  the  brain  which  this 
disorder  occupied  was  larger  than  that  which  the  largest  walnut  would  have  taken  up ;  and 
that  color  of  the  bloody  fluid  was  most  manifest  in  the  middle  thereof.  It  was  more  na- 
tural to  take  notice  of  this  difference,  because  the  cerebrum  in  general,  as  I  said,  was  of  its 
natural  color,  and  not  only  more  hard  than  the  cerebellum,  but  even  endowed  with  a  won- 
derful hardness  everywhere,  especially  in  the  whole  right  hemisphere,  and  had  only,  in  that 
place  I  have  mentioned,  a  kind  of  bloody  color,  and  a  loose  ill-compacted  substance. 

"  I  believe  that  this  was  an  apostema  sui  generis,  which  is  agreeable  to  the  opinion  even  of 
Avicenna,  that  an  apoplexy  might  have  its  origin  '  from  an  apostem  formed  by  repletion ;' 
the  violence  of  which  was  increased  in  the  patient  in  question  by  the  water  being  extrava- 
sated,  and  by  the  vessels  being  distended.  But  this  apostem  happened  about  the  very  place 
in  which,  as  I  have  already  said,  organical  injuries  most  frequently  happen  according  to  my 
observations." 

The  accurate  account  which  Morgagni  has  given  of  the  post-mortem 
appearances  in  this  case  can  leave  no  doubt  as  to  the  real  character  of  the 
lesion;  and  it  is  extraordinary  that  it  should  have  escaped  observation 
for  so  long  a  period  after  the  celebrated  author  of  the  work  "  On  the 
Causes  and  Seats  of  Diseases"  wrote  ;  for  until  Rostan  published  his 
"Recherches  sur  le  Ramollissement  du  Cerveau,"  the  second  edition  of 
which  appeared  in  1823,  softening  of  the  substance  of  the  brain  seems 
to  have  been  entirely  overlooked  by  the  pathologists  of  Europe. 

In  the  present  day,  however,  no  one  ought  to  have  any  difficulty  in 
distinguishing,  after  death,  the  morbid  appearances  designated  ramol- 
lissement by  the  French  writers,  and  softening  by  the  English.  But 
whether  this  lesion  is  the  result  of  inflammation,  or  whether  it  is  a  dis- 
ease sui  generis,  has  not  been  so  clearly  decided.  Lallernand  believes 
that  ramollissement  is  invariably  the  result  of  an  inflammatory  process, 
while  Andral  does  not  allow  that  this  matter  is  yet  decided.  But  we 
will  quote  AndraPs  own  words  ;  after  pointing  out  the  different  appear- 
ances, he  says:* — "  Do  these  different  appearances  which  may  be  pre- 
sented by  softening  of  the  brain,  refer  to  lesions  of  a  different  nature  ? 
Are  they  but  degrees  more  or  less  advanced  of  one  and  the  same  dis- 
ease ?  It  is  easy  to  prove  that  in  a  considerable  number  of  cases  the 
substance  of  the  brain  is  first  injected,  then  softened,  then  secretes  pus. 
This  has  been  excellently  well  established  by  M.  Lallemand.  The  soft- 
ening is  then  one  of  the  anatomical  characters  of  inflammation  of  the 
brain,  as  it  may  be  of  all  other  organs.  But  if,  in  other  cases,  we  do  not 
find  within  the  softening  any  trace  either  of  sanguineous  injection,  or 
purulent  infiltration  ;  if  we  find  there,  in  a  word,  no  other  alteration  than 
softening  itself,  will  it  not  be  an  abuse  of  analogy  to  conclude  that  in 
these  cases  also,  the  cause  which  has  deprived  the  brain  of  its  consist- 
ence is  inflammation  ?  Ji  fortiori,  will  not  one  be  induced  to  admit  it 
in  those  other  cases  where  the  softened  part  has  become  at  the  same 
time  the  seat  of  an  anaemia?  Observe,  besides,  that  among  those  cases 
of  white  softening,  there  are  some  which  have  formed  very  rapidly,  after 
the  manner  of  acute  diseases,  and  in  such  cases  it  cannot  be  supposed 
that  the  softening  has  commenced  by  a  sanguineous  congestion,  which 
would  disappear,  according  as  the  affection  would  assume  a  chronic 
course.  No  doubt  those  who  refer  the  proximate  cause  of  every  disease 
to  a  defect  of  the  normal  stimulation,  must  necessarily  make  cerebral 

*  0P.cit,p.l60. 


292  HUMAN   BRAIN. 

softening  enter  into  one  or  other  of  these  states,  and  not  finding  in  this 
alteration  the  characters  of  an  asthenic  disease,  must  regard  it  as  an  in- 
flammation." 

"  In  thinking  so,  they  but  follow  their  theories ;  but  for  us,  who  think 
that  in  a  crowd  of  morbid  states  there  is  no  more  hypersthenia  than 
asthenia,  but  mere  perversion  of  the  vital  actions,  we  are  no  more  obliged 
to  consider  the  cerebral  softening  or  any  other  softening  as  an  inflamma- 
tion than  tuberculous  pneumonia.  It  is  a  specific  alteration  of  nutrition, 
which  may  supervene  under  the  influence  of  morbid  conditions  widely 
differing  from  each  other.  To  endeavor  to  determine  these  different 
conditions  is  the  task  to  be  performed — a  task,  difficult,  no  doubt,  but 
of  quite  another  importance  from  that  on  which  medical  men  have  occu- 
pied themselves  in  latter  times,  when  they  have  wished  to  reduce  every 
cerebral  softening  to  one  of  the  forms  or  one  of  the  degrees  of  inflamma- 
tion of  the  nervous  centres.  We  are  convinced  that  by  proceeding  thus, 
men  have  entered  on  a  course  diametrically  opposite  to  that  which  should 
lead  to  the  truth.  We,  too,  might  collect  groups  of  facts  to  demonstrate 
that  softening  is  capable  of  being  produced  by  different  causes  of  inflam- 
mation. Thus  we  might  find  some  group  from  which  it  would  result  that 
commencing  obliteration  of  the  arteries  which  enter  the  brain,  is  one  of 
the  conditions  which  concur  in  the  production  of  a  certain  number  of 
softenings.  We  might  cite  other  facts  which  would  show  us  a  remark- 
able coincidence  between  the  impoverishment  of  the  blood,  or  any  other 
alteration  whatever  of  this  liquid,  and  the  softening  of  a  great  number 
of  our  tissues.  Are  there  really  so  many  causes  of  softening?  The 
future  will  decide,  and  will  discover,  no  doubt,  many  other  causes  which, 
in  the  present  state  of  our  knowledge,  we  cannot  even  suspect.  All 
that  we  affirm  is,  that  it  is  necessary  to  seek  elsewhere  than  in  inflam- 
mation for  the  cause  of  all  softenings.  It  does  not  even  seem  to  us  that 
the  presence  of  an  unusual  quantity  of  blood  in  the  midst  of  a  softened 
tissue  is  a  sufficient  proof  that  irritation  is  the  cause  of  its  softening. 
May  it  not  be  that  this  superabundant  blood  has  flowed  into  these  softened 
parts  but  consecutively  ?  See  the  case  where,  after  a  limb  has  remained 
for  a  long  time  merely  paralyzed,  it  suddenly  became  rigid,  convulsed 
and  contracted;  on  opening  the  body  we  often  find,  in  such  cases,  one 
part  of  the  brain  softened,  and  at  the  same  time  reddened  with  blood  : 
reasoning  may  then  lead  us  to  admit  that  the  sanguineous  congestion 
occurred  but  as  a  mere  complication  of  softening,  and  that  it  is  this 
which  caused  the  phenomena  of  excitement  to  succeed  the  simple  loss 
of  motion.  In  order  to  explain  a  cause  which  simultaneously  softened 
and  reddened  a  tissue,  shall  we  never  see  anything  beyond  the  mere  fact 
of  an  irritation  which  has  acted  on  this  tissue  ?  Is  it  then  in  the  gums 
of  a  scorbutic  subject  that  the  cause  resides  which  has  brought  them  at 
the  same  time  to  a  state  of  hyperaBmia,  and  deprived  them  of  their  con- 
sistence ?" 

"Here,  no  doubt,  are  very  many  questions  raised  which  wait  till  facts 
rigorously  observed  shall  come  to  solve  them.  But  it  is  enough,  we 
think,  that  such  questions  can  be  put,  and  that  in  the  future  progress 
of  science  their  solution  is  possible,  to  make  one  distrust  very  much 
Jhe  opinion  which  refers  every  softening  to  an  inflammation.  Because 


ANAEMIC   RAMOLLISSEMENT.  293 

the  brain  is  softened  after  a  blow  on  the  cranium,  is  that  a  reason  for 
saying  that  every  time  it  shall  have  lost  its  consistence  it  must  have  been 
previously  irritated  ?" 

"  If  science Tefuse  to  admit  inflammation  as  the  sole  cause  of  soften- 
ing the  brain,  if  it  see  in  this  softening  several  other  causes,  for  the  proof 
of  which  it  waits  for  new  researches,  it  is  quite  clear  that  the  term  en- 
cephalitis cannot  be  used  as  synonymous  with  the  word  softening. 
Neither  do  we  think  it  correct  to  call  this  alteration  capillary  apoplexy, 
as  M.  Cruveilhier  has  done.  In  a  certain  number  of  cases,  to  be  sure, 
the  softening  is  accompanied,  or,  rather,  complicated  with  sanguineous 
infiltration,  or  effusions  of  blood  more  or  less  multiplied  ;  but  certainly 
it  is  not  in  the  presence  of  this  blood  that  the  essence  of  the  disease 
consists,  and  there  are  at  least  many  cases  in  which  we  do  not  find  the 
least  trace  of  it.  The  softening  may  then  be  either  a  capillary  apoplexy 
or  an  encephalitis ;  but  it  is  not  necessarily  either  the  one  or  the  other." 

Dr.  Abercrombie,*  in  speaking  of  ramollissement,  says,  "  When  I 
formerly  endeavored  to  contribute  something  to  the  pathology  of  this 
remarkable  affection,  I  had  no  hesitation  in  considering  it  as  one  of  the 
results  of  inflammation  of  the  cerebral  substance  ;  since  that  time  it  has 
been  investigated  with  much  attention  by  M.  Rostan  and  other  French 
pathologists,  and  a  different  view  of  the  nature  of  the  affection  has  been 
strongly  contended  for  by  these  eminent  individuals.  They  consider  it 
as  an  affection  of  the  brain  entirely  sui  generis,  and  M.  Rostan,  in  par- 
ticular, seems  to  look  upon  it  as  a  peculiar  and  primary  disease  of  the 
brain,  though  he  admits  it  is  sometimes  the  result  of  inflammation. 
From  all  the  facts  which  are  now  before  us  in  regard  to  this  interesting 
affection,  I  think  we  are  enabled  to  arrive  at  the  conclusion  that  it  occurs 
under  two  modifications  which  differ  essentially  from  each  other.  In  the 
cases  of  M.  Rostan  the  disorganization  was  observed  chiefly  in  the  exter- 
nal parts  of  the  brain :  it  occurred  almost  entirely  in  very  old  people,  many 
of  them  seventy,  seventy-five,  and  eighty.  It  was  found  in  connection 
with  attacks  of  a  paralytic  or  apoplectic  kind,  many  of  them  protracted, 
and  was  often  found  combined  with  extravasation  of  blood,  or  surround- 
ing old  apoplectic  cysts.  On  the  contrary,  the  affection  which  I  had 
been  anxious  to  investigate,  was  found  chiefly  in  the  dense  central  parts 
of  the  brain,  the  fornix,  septum  lucidum,  and  corpus  callosum,  or  in  the 
cerebral  matter  immediately  surrounding  the  ventricles ;  and  occurred  in 
persons  of  various  ages,  but  chiefly  in  young  people  and  in  children. 
It  took  place  in  connection  with  attacks  of  an  acute  character,  chiefly 
the  character  of  acute  hydrocephalus  ;  and  it  was  in  many  cases  dis- 
tinctly combined  with  appearances  of  an  inflammatory  kind,  such  as 
deep  redness  of  the  cerebral  matter  surrounding  it,  suppuration  border- 
ing upon  it,  and  deposition  of  false  membrane  in  the  membranous  parts 
most  nearly  connected  with  it.  We  may  even  observe,  in  different  parts 
of  the  same  diseased  mass,  one  part  in  the  state  of  ramollissement,  an- 
other forming  an  abscess,  while  a  third  retains  the  characters  of  active 
inflammation,  and  probably  exhibits,  as  we  trace  it  from  one  extremity 
to  the  other,  the  inflamed  state  passing  gradually  into  the  state  of  soften^ 

*  Op.  cjt,  p.  24. 

>  JiiuttUi*  ;   *jiia 


294  HUMAN    BRAIN. 

ing.  Remarkable  examples  of  this  will  be  given  in  the  sequel,  and  an- 
other of  a  different  nature,  in  which  an  opening  in  the  septum  lucidum 
produced  by  the  ramollissement  was  entirely  surrounded  by  a  ring  of 
inflammation.  This  is  the  affection  which  I  have  endeavored  to  inves- 
tigate, and  which  I  consider  as  one  of  primary  importance  in  the  patho- 
logy of  acute  affections  of  the  brain,  and  upon  the  grounds  now  shortly 
referred  to,  I  cannot  hesitate  to  consider  it  as  a  result  of  inflammation." 

u  When  we  compare  the  facts  now  alluded  to  with  the  observations  of 
M.  Rostan  and  his  friends,  I  think  we  may  arrive  at  a  principle  by  which 
the  apparent  difference  may  be  reconciled.  The  principle  to  which  I 
refer  is,  that  this  peculiar  softening  of  the  cerebral  matter  is  analogous 
to  gangrene  in  other  parts  of  the  body ;  and  that,  like  gangrene,  it  may 
arise  from  two  different  causes,  inflammation,  and  failure  of  the  circula- 
tion from  disease  of  the  arteries.  The  former  I  conceive  to  be  the  origin 
of  the  affection  which  I  have  described,  and  the  latter  to  be  the  source 
of  the  appearances  described  by  M.  Rostan.  If  this  doctrine  be  ad- 
mitted, the  difficulty  is  removed;  and  I  do  not  see  any  good  objection 
to  it." 

"  Gangrene  from  inflammation  is  familiar  to  every  one  ;  and  equally 
familiar,  though  very  different  in  its  origin  and  concomitant  symptoms, 
is  gangrene  from  disease  of  the  arteries  of  any  particular  part  of  the 
body.  Ossification  of  the  arteries  of  the  brain  to  a  very  great  extent  is 
a  common  appearance  in  elderly  people,  and  seems  to  be  a  very  frequent 
source  of  apoplexy,  with  extravasation  of  blood,  at  advanced  periods 
of  life.  It  appears  extremely  probable  that  it  may  be  the  source  of  that 
particular  condition  of  a  part  of  the  brain  which  terminates  in  the  ramol- 
lissement of  M.  Rostan,  and  indeed  he  distinctly  points  at  this  explana- 
tion of  it.  On  the  other  hand  I  am  still  disposed  to  contend  that  the 
ramollissement  of  young  persons  occurring  in  acute  affections,  and 
seated  chiefly  in  the  central  parts,  is  one  of  the  terminations  of  inflam- 
mation in  that  particular  structure.  I  conceive  it  to  be  an  affection  of 
primary  importance  in  the  pathology  of  acute  affections  of  the  brain, 
and  to  mark  a  peculiar  seat  of  the  inflammation  of  very  frequent  occur- 
rence. It  is  often  combined  with  suppuration  in  other  parts  of  the  brain, 
and  very  often  with  effusion  in  the  ventricles  ;  but  the  peculiar  interest 
of  it  is  observed  in  those  cases  in  which  it  is  only  the  morbid  appear- 
ance, and  in  which  it  is  sometimes  of  small  extent.  Of  this  some  re- 
markable examples  will  be  given  in  the  sequel,  in  which  the  perforation 
of  the  septum  lucidum,  by  softening  of  a  part  of  its  substance,  and 
similar  softening  of  the  fornix,  were  the  only  morbid  appearances  in 
cases  which  were  fatal,  with  all  the  usual  symptoms  of  acute  hydroce- 
phalus." 

On  reconsidering  all  these  different  opinions,  and  more  particularly 
the  simple  but  clear-sighted  views  of  Dr.  Abercrombie,  we  are  war- 
ranted in  concluding  that  the  morbid  appearance  called  ramollissement 
is  usually  the  result  of  acute  inflammatory  action,  but  that  in  old  people 
it  frequently  follows  a  total  failure  of  the  circulation,  corresponding, 
both  in  its  consequence  and  in  the  cause  producing  it,  to  asthenic  senile 
gangrene  in  other  parts,  and  also  that  it  may  be  the  consequence  of  local 
and  general  anaemia  even  in  joung  subjects.  The  question  regarding 


ANAEMIC    RAMOLLISSEMENT.  295 

its  inflammatory  character  is  peculiarly  interesting  to  the  physiologist, 
from  deductions  he  may  draw  from  the  effects  which  its  first  stage  pro- 
duces on  the  functions  of  the  brain,  a$  distinguished  from  those  exhi- 
bited after  the  disease  has  pursued  its  course  to  the  actual  destruction 
of  its  texture. 

Gluge,*  Henle,f  Valentin, J  Wagner,§  and  Dr.  Hughes  Bennett,  of 
Edinburgh,  have  made  some  most  important  and  interesting  observations 
on  ramollissement  of  the  brain.  To  the  papers||  of  this  last-mentioned 
excellent  pathologist  I  am  indebted  for  the  following  information  on  this 
subject.  Gluge  was  the  first  to  point  out,  not  only  in  softening  of  the 
brain,  but  that,  in  certain  stages  of  inflammation  generally,  corpuscles 
are  produced,  which  he  has  denominated  compound  inflammation  glob- 
ules. The  blood  in  the  capillary  vessels  stands  still.  The  blood  cor- 
puscles lose  their  coverings  and  color,  only  their  nuclei  remaining. 
These  become  agglomerated  by  means  of  a  white  connecting  mass,  and 
form  thick  opaque  round  bodies,  which  consist  on  an  average  of  from 
twenty  to  thirty  small  granules,  which,  when  examined  singly,  are  per- 
fectly clear  and  transparent.  Henle  has  shown  that  these  granules  are 
contained  in  a  true  cell-wall  with  a  nucleus.  Valentin,  Vogel,  and 
Dr.  H.  Bennett  concur  in  this  view  of  their  structure. 

Dr.  H.  BennettH  thus  describes  the  mode  in  which  these  exudation 
corpuscles  are  developed  : — u  The  blood-plasma  or  liquor  sanguinis, 
which  exudes  through  the  walls  of  the  blood-vessels,  after  a  time,  which 
may  be  shorter  or  longer,  according  to  circumstances,  coagulates  in  the 
form  of  minute  granules.  These  may  be  seen  coating  the  vessels,  and 
filling  up  the  spaces  between  them  in  masses  more  or  less  dense.  If  a 
small  quantity  only  be  exuded,  the  granules  occur  in  small  patches  at 
irregular  intervals.  (Plate  I.  fig.  5.)  This  appears  to  arise  from  a  com- 
paratively slight  degree  of  congestion,  which,  however,  may  produce 
very  intense  symptoms  from  its  diffusion  over  a  large  surface,  as  in  cases 
of  fever,  delirium  tremens,  &c.  When,  on  the  other  hand,  the  conges- 
tion is  more  intense  in  certain  places,  the  exudation  is  more  abundant, 
and  the  granules  accumulate  in  a  dense  mass  outside  the  vessels,  or  in 
the  interstices  of  the  elementary  structures  of  the  organ.  (Plate  I.  fig. 
4.)  This  exudation  serves  as  a  blastema  for  the  production  and  nourish- 
ment of  nucleated  cells.  These  may  either  be  formed  directly  from  the 
fluid  liquor  sanguinis  or  subsequent  to  its  coagulation.  In  the  former 
case  these  may  be  seen  coating  the  blood-vessels  (see  Journal,  No.  153, 
Plate  V.  fig.  6).  In  the  latter  imbedded  in  the  granular  solid  mass  (fig. 
7,  8).  In  parenchymatous  tissues,  where  the  whole  exudation  passes 
into  solid  coagulation,  it  is  the  growth  and  development  of  these  cor- 
puscles which  cause  it  to  break  up,  and  gradually  become  more  and 
more  soft.  Thus  we  have  uniformly  seen  that  when  the  softening  is 
diffluent,  perfect  corpuscles  are  few,  and  that  the  granules  are  numerous 

*  Anat.  Mikroscopische  Untersuchungen,  pp.  12,  13. 

t  Mftller's  Archives,  1839,  p.  24. 

J  Vogel  uber  die  Erwachung  des  Gehirns. 

§  Wagner,  Handworterbuch  der  Physiologic. 

1!  Ed.  Med.  &  Surg.  Journal,  vpl.  Iviii.  pp,  58  and  60. 

V  Ibid.,  vol.  lix.  p.  344, 


296  HUMAN    BRAIN. 

and  loose.  When  it  is  pultaceous,  only  the  corpuscles  are  numerous, 
and  the  granules  less  so  ;  and  when  the  diseased  part  retains  to  a  con- 
siderable degree  its  resistance,  or  is  unchanged,  the  corpuscles  are  few, 
whilst  the  granules,  instead  of  floating  loose,  are  attached  to  and  coat 
the  blood-vessels.  During  the  progress  of  disintegration,  it  frequently 
happens  that  portions  of  the  solid  exudation  are  broken  up  into  masses 
of  greater  or  less  size,  which  are  frequently  seen  of  irregular  shapes, 
both  attached  to  the  vascular  walls,  and  floating  loose  in  the  field  of  the 
microscope." 

"The  exudation  corpuscle  is  formed  like  all  other  primary  cells — a 
nucleus  is  produced,  from  which  a  cell-wall  arises.  During,  or  subse- 
quent to  its  full  growth,  granules  are  formed  between  the  nucleus  and 
cell-wall.  These  become  more  and  more  numerous,  until  at  length  the 
nucleus  is  obscured,  and  the  whole  cell  appears  full  of,  and  distended 
with  granules.  It  presents  different  appearances  at  different  periods 
of  its  growth.  At  an  early  period  it  is  very  delicate  and  transparent; 
the  "nucleus  is  very  distinct,  like  a  white  spot,  and  the  granules  exceed- 
ingly minute,  and  few  in  number.  As  the  development  proceeds,  the 
granules  become  larger  and  more  numerous,  the  corpuscle  assumes  a 
brownish  color  and  becomes  more  or  less  opaque.  Sometimes  it  en- 
tirely obstructs  the  rays  of  light,  and  looks  black.  In  the  observation 
where  the  softening  resembled  chalky  milk,  the  whole  cell  was  full  of 
granules  of  a  large  size,  each  of  which  was  perfectly  round  and  trans- 
parent." 

"When  the  exudation  corpuscle  is  distended  with  granules,  it  appears 
to  have  reached  its  furthest  stage  of  development:  the  cell-wall  now 
bursts,  and  its  contents  escape.  This  occurring  in  numerous  corpuscles, 
causes  the  coagulated  exudation  to  become  soft,  pultaceous,  or  even 
diffluent.  When,  by  the  process  of  organization  thus  described,  the  ex- 
uded mass  is  broken  down,  it  appears  probable  that  the  minute  granules 
or  molecules,  of  which  it  now  principally  consists,  may  be  re-absorbed, 
the  structures  of  the  organ  set  free  from  the  pressure  the  exudation  pro- 
duced, and  thus  the  part  return  to  a  healthy  state.  Gruly  tells  us,  that 
he  has  seen  the  molecules  thus  produced  by  the  breaking  down  of  pus 
cells,  permeate  the  coats  of  the  intermediary  and  capillary  vessels,  and 
mix  with  the  blood.  This  is  the  process  by  which  it  seems  probable 
that  hepatization  of  the  lungs  is  removed.  It  is  impossible,  however, 
Jo  know  with  certainty  whether  a  similar  process  takes  place  in  the  brain, 
because  the  symptoms  of  exudation  into  that  organ  are  by  no  means  so 
unequivocal,  but  it  is  highly  probable.  More  generally,  however,  ab- 
sorption either  does  not  take  place,  or  is  not  in  proportion  to  the  amount 
of  exudation  poured  out,  and  the  ultimate  structure  of  the  organ  is  also 
at  length  broken  up  and  disorganized.  Thus,  when  inflammatory  soft- 
ening of  the  brain  is  diffluent,  not  only  is  the  exudation  mass  reduced 
to  granules,  but  the  cylindrical  and  varicose  nervous  tubes  are  broken 
up  into  fragments  more  or  less  long." 

"  Dr.  Henderson,  in  an  interesting  paper  on  pneumonia,  was  the 
first  to  point  out  a  distinction  between  the  different  granular  bodies 
resulting  from  exudation,  as  he  has  observed  them  in  inflamed  lungs. 
He  says,  l  They  do  not  always  present  in  their  agglomerated  form  the 


RAMOLLISSEMENT.  297 

figure  described  by  Gluge,  but  are  variously  shaped,  according  to  the 
state  of  perfection  in  which  they  may  happen  to  be;  while  some  are 
globular  and  exhibit  a  circular  outline,  others  appear  deeply  indented 
and  defective,  as  if  a  portion  of  their  substance  had  been  removed  ;  and 
others  have  nothing  of  their  original  round  figure  remaining.'  I  think 
it  will  appear  that  these  differences  do  not  arise  from  the  stages  of  de- 
velopment of  the  exudation  corpuscle,  as  Dr.  Henderson  supposes,  but 
are  caused  by  the  coagulated  blood-plasma  breaking  up  into  different- 
sized  masses.  I  have  frequently,  by  means  of  friction,  caused  such  por- 
tions of  coagulated  exudation  to  separate,  to  peel  off,  as  it  were,  from 
the  exterior  of  the  vessels,  and  float  loose  amongst  the  granules  and  cor- 
puscles. These  bodies  I  have  distinguished  by  the  term  exudation 
masses." 

Dr.  Hughes  Bennett  has  shown  that  the  most  important  changes  may 
take  place  in  the  cerebral  substance,  inappreciable  to  the  naked  eye, 
but  clearly  discernible  with  the  microscope.  He  also  distinguished 
more  decidedly  than  had  been  done  previously,  the  inflammatory  and 
non-inflammatory  softening. 

The  following  case  illustrates  very  strikingly  the  value  of  the  micro- 
scope in  the  examination  of  the  brain.  It  quite  confirms  the  opinion  I 
have  always  expressed,  that  every  decided  deviation  from  the  normal 
action  of  the  brain  would  be  always  found  to  correspond  to  some  altera- 
tion of  structure,  and  that  it  was  only  owing  to  the  imperfect  manner  in 
which  we  have  hitherto  examined  the  brain  that  we  failed  to  detect  these 
alterations. 

Case  9. — Acute  hydrocephalus;  death  ten  days  after  the  commencement  of  the  disease; 
nothing  abnormal  in  the  brain.  Vessels  of  the  convolutions  abundantly  coated  with  exuda- 
tion granules. — John  Smith,  aged  3  years,  admitted  into  the  Royal  Infirmary,  under  Dr. 
Traill,  February  12th,  1842. 

According  to  the  mother's  account,  he  awoke  during  the  night  of  the  3d  instant  with  a 
]oud  scream,  and,  by  pointing  to  his  head,  seemed  to  indicate  that  he  felt  pain  there.  On 
the  following  day  he  vomited  repeatedly,  and  he  has  since  refused  all  food.  On  admission 
there  was  constant  rolling  of  the  head ;  pupils  contracted  on  the  approach  of  light ;  pulse 
quick  and  sharp ;  bowels  regular.  Two  leeches  to  the  head  5  powders  of  calomel  and  sugar 

Feb.  13th.  Vomited  powder ;  passed  a  restless  night;  some  tremor  observed  in  the  limbs. 
Blister  to  the  head;  clyster;  became  restless,  and  died  during  the  night. 

Sectio. — Feb.  15.  The  membranes  covering  the  brain  displayed  no  unusual  vascularity. 
The  ventricles  contained  no  fluid,  nor  was  the  consistence  of  the  cerebral  substance  in  any 
way  altered. 

Microscopic  examination. — The  vessels  of  the  convolutions  were  in  many  places  slightly 
coated  with  exudation  granules.  The  fornix  and  central  medullary  parts  of  the  brain  pre- 
sented a  similar  appearance.  The  coating  of  granules  here,  however,  was  frequently  two 
and  even  three  times  thicker  than  the  vessel  to  which  it  was  attached,  and  contained  here 
and  there  clear,  round  white  spots,  similar  to  the  nuclei  of  the  exudation  corpuscles. 

Remarks. — This  case  presented  the  usual  symptoms  of  acute  hydrocephalus  in  children, 
yet  after  death  no  morbid  lesion  of  any  consequence  was  to  be  discovered.  This  is  a  cir- 
cumstance of  by  no  means  unusual  occurrence.  A  more  minute  examination,  however, 
determined  that  the  capillaries  of  the  central  substance  of  the  brain  were  coated  with  exu- 
dation granules  to  a  very  great  extent,  and  that  these  granules  contained  among  them  nume- 
rous bodies  similar  to  the  corpuscular  nuclei.  That  the  exudation  in  this  case  should  have 
presented  this  condition,  notwithstanding  the  violent  symptoms,  is  very  curious,  and  in  a 
histological  point  of  view,  exceedingly  interesting.  It  furnishes  us  with  an  intermediate 
stage  in  the  development  of  the  exudation  corpuscle,  as  seen  in  many  of  the  preceding  cases, 
on  the  one  hand,  and  those  which  are  to  follow  on  the  other. 

Dr.  Bennett  thus  sums  up  his  conclusions  regarding  the  two  kinds  of 
softening  :* — 

*  Vol.  lx.  p.  398. 


298  HUMAN    BRAIN. 

1.  That  two  kinds  of  cerebral  and  spinal  softening  exist,  an  inflam- 
matory and   a  non-inflammatory,  which  may   always  be   distinguished 
from  each  other  by  means  of  the  microscope. 

2.  That  inflammatory  softening  is  characterized   by  the  presence  of 
exudation  corpuscles  and  granules,  whilst  in  non-inflammatory  softening 
these  bodies  are  never  found. 

3.  That  the  nature  of  inflammatory  softening  consists  in  the   forma- 
tion and  development  of  nucleated  cells  in  exuded  blood-plasma:  whilst 
the  nature  of  non-inflammatory  softening  consists  in  the  mechanical  de- 
struction or  maceration  of  the  nervous  tissue  in  serum,  or  is  the  result 
of  putrefaction. 

4.  That  non-inflammatory  softening,  unaccompanied  by  hemorrhage, 
is  usually  post-mortem^  and  causes  no  symptoms;   whilst  uncomplicated 
inflammatory  softening  always  causes  marked  symptoms,  which,  how- 
ever, vary  according  to  the  seat  of  the  lesion. 

5.  That  the  inflammatory  and  non-inflammatory  softenings  have  fre- 
quently been  confounded  together  by  morbid  anatomists,  it  being  impos- 
sible* to  distinguish  one  from  the  other  with  any  certainty  by  the  naked 
eye. 

6.  That  inflammation  in  the  nervous  centres  has,  in  several  instances, 
been  demonstrated  by  means  of  the  microscope,  after  it  has  escaped  the 
search  of  good  morbid  anatomists,  and  been  indicated  by  most  unequi- 
vocal symptoms. 

7.  That  every  different  colored  softening  has,  at  various  times,  been 
found   to  be  connected  with   inflammation,  but  that  yellow  and  white 
softenings  are  most  frequently  non-inflammatory,  whilst  the  fawn-colored 
softening  is  non-inflammatory. 

8.  That  red  softenings  usually  depend  on  congestion^  or  the  direct 
extravasation  of  blood  ;  yellow  softenings  on  the  imbibition  of  the  co- 
loring-matter of  the  blood ;   fawn  and  gray-colored  softenings  on  the 
presence  of  gray  exudation   corpuscles;  and  white  softenings,  in  the 
great  majority  of  cases, -are  post-mortem,  and  the  result  of  maceration  in 
serum. 

9.  In  no  single  instance  has  softening  of  the  nervous  centres  been 
traced  to  the  presence  or  infiltration  of  pus. 

10.  That  inflammation  of  the  central  parts  of  the  brain  generally  pro- 
duce well-marked  lesions  of  sensation  and  motion  ;  whilst  in  inflamma- 
tion of  the  peripheral  portions,  lesions  of  intelligence  are  commonly  well 
pronounced. 

11.  That  in  idiopathic  inflammatory  softening  of  the  brain,  contraction 
in  one  or  more  limbs  is  a  common  symptom. 

12.  That  the  fawn-colored  spots,  described  by  Dr.  Sims,  are  no  evi- 
dence of  the  cure  of  inflammatory  softening. 

13.  That  inflammation   accompanying  haemorrhages  is  usually  conse- 
cutive. 

14.  The  softening  surrounding  apoplectic  clots,  or  sanguineous  infil- 
tration, is  no  proof  of  inflammatory  action. 

The  following  highly  important  communication  on  this  subject,  I  have 
received  from  my  esteemed  colleague,  Dr.  Peacock.  Knowing  his  ac- 
curacy, I  have  no  hesitation  in  publishing  it  in  full. 


RAMOLLISSEMENT.  299 

"  From  the  opportunity  which  I  had  in  Edinburgh  of  observing  Dr.  Bennett's  researches  into 
the  microscopic  structure  of  softened  portions  of  the  brain,  and  from  a  considerable  number  of 
cases  of  cerebral  disease  which  I  have  since  dissected  and  minutely  examined,  the  following 
points  may,  1  think,  be  regarded  as  established : — 

"1st.  That  in  all  cases  where  characteristic  symptoms  of  softening  of  the  brain  are  pre- 
sent during  life,  evidences  will  be  found,  on  microscopic  examination,  of  the  extravasation 
of  lymph  into  the  cerebral  substance  under  one  or  other  of  the  several  forms  of  the  so-called 
exudation  granules,  corpuscles,  or  masses: 

a  2dly.  That  the  appearance  of  portions  of  the  brain  softened  after  death,  either  arti- 
ficially, by  manipulation,  or  from  post-mortem  change,  often,  to  the  naked  eye,  so  closely  re- 
sembles the  genuine  results  of  disease  as  to  render  it  extremely  difficult,  if  not  impossible, 
for  practised  morbid  anatomists  to  decide  between  them : 

"  3dly.  And  consequently  that  portions  of  brain,  presenting  every  appearance  of  soften- 
ing to  the  naked  eye,  but  in  which  the  microscope  does  not  reveal  the  presence  of  some 
form  of  exudation,  intermixed  with  the  broken-up  cerebral  substance,  cannot,  in  the  present 
state  of  our  knowledge,  be  regarded  as  having  resulted  from  any  diseased  process  during 
life. 

"In  support  of  these  propositions,  I  have  selected  the  two  following  cases  from  a  number 
of  unpublished  observations  of  my  own;  they  will  be  observed  to  confirm  several  of  Dr. 
Bennett's  conclusions,  and  show,  1st,  that  softening  of  the  brain  may  prove  fatal  at  a  period 
when  the  local  changes  are  so  little  apparent,  as  to  be  scarcely  detectable  to  the  unaided 
sight,  yet  that,  in  this  stage,  their  nature  may  be  rendered  conclusive  on  microscopic  exami- 
nation; 2dly,  that  in  the  same  brain  there  may  exist  softenings  essentially  resulting  from 
morbid  processes  during  life,  and  others  dependent  simply  on  changes  after  death ;  and  that 
the  respective  nature  of  these,  not  certainly  capable  of  solution  by  ordinary  vision,  become 
apparent  when  recourse  is  had  to  the  use  of  the  lens. 

"  Case  I. — Vourdelot,  a  female,  69  years  of  age,  was  admitted  into  the  Salle  St.  Madeline, 
at  La  Charite,  under  the  care  of  M.  Bouillaud,  on  the  23d  of  February,  1844. 

"She  stated  that  she  had  been  seized  on  awaking  the  morning  before  with  entire  loss  of 
motion  and  general  numbness  in  the  left  arm  and  leg,  in  consequence  of  which  she  was 
incapable  of  leaving  the  bed.  The  morning  of  her  admission  she  had  some  pain  in  the 
head,  and  felt  giddy  when  sitting  up ;  she  had  not  had  any  feeling  of  sickness  or  vomiting. 
When  admitted  she  looked  sallow  and  feeble,  but  had  no  particular  expression  of  suffering. 
The  angle  of  the  mouth  was  slightly  drawn  to  the  right  side.  The  tongue  did  not  present 
any  material  deviation,  and  was  freely  movable ;  it  was  moist  and  somewhat  red.  The 
pupils  were  of  natural  size,  and  sensible  to  light;  the  hearing  was  entire.  She  had  some 
difficulty  of  speaking  and  swallowing.  The  leg  and  arm  were  entirely  paralyzed ;  and  the 
forearm  was  flexed  upon  the  arm,  and  rigid.  She  had  experienced  some  difficulty  of  mak- 
ing water,  but  the  bowels  had  been  naturally  relieved.  The  pulse  was  88,  and  sufficiently 
strong.  There  was  no  increased  dullness  in  the  region  of  the  heart,  and  the  sounds,  though 
flat,  were  far  from  morbid  murmur.  •  The  respiration  was  natural.  She  referred  the  pain 
in  the  head  to  the  upper  and  middle  part  of  the  right  side  ;  she  had  no  giddiness  except 
when  sitting  up ;  the  intelligence  was  scarcely  impaired.  She  was  directed  to  be  bled  to  3 
palettes. 

"  On  the  24th,  the  paralysis  continued  much  as  before,  and  was  combined  with  semiflexion 
of  the  joints,  which  ceased  on  extension.  The  mouth  was  slightly  drawn  to  the  right  side. 
The  lips  had  their  natural  movement  when  she  attempted  to  blow ;  the  motions  of  the  eye- 
lids were  natural.  The  pulse  was  88,  and  firm;  the  heat  of  skin  moderate.  The  blood 
drawn  the  night  before  was  moderately  contracted,  and  without  any  buffy  coat.  M.  Bouil- 
laud gave  as  his  diagnosis — Cerebral  hemorrhage  in  the  optic  lobes,  or  corpus  striatum,  of 
the  right  side,  or  in  their  immediate  neighborhood,  with  softening  of  the  cerebral  substance 
around,  probably  ossification  of  the  central  arteries.  The  symptoms  underwent  little  change 
after  this  date.  The  power  of  speech,  which  had  never  been  greatly  affected,  was  much 
improved  after  the  bleeding,  and  the  intelligence  continued  perfect.  The  contraction  and 
rigidity  of  the  left  arm  were  very  irregular  ;  though  decided  on  the  evening  of  her  admission, 
it  was  nearly  absent  at  the  time  of  M.  Bouillaud's  visit  the  following  morning ;  and  again  in 
the  evening  it  existed,  though  not  to  a  great  degree.  The  left  leg  was  throughout  in  a  state 
of  complete  resolution,  and  the  sensibility  was  unaffected  in  both  limbs. 

"On  the  25th,  the  bowels  not  having  been  relieved,  she  was  directed  to  take  one  grain  of 
the  potassio-tartrate  of  antimony  in  a  basin  of  broth  ;  portions  being  drank  at  intervals.  This 
did  not  produce  vomiting,  but  acted  moderately  on  the  bowels.  Towards  the  evening  she 
became  delirious  and  restless,  then  sank  into  a  state  of  coma,  and  died  at  5  A.M.  on  the  26th. 

"  The  body  was  examined  at  9  A.M.  on  the  27th.  The  heart  was  of  large  size,  the  walls 
of  the  left  ventricle  being  unusually  thick,  and  its  «avity  small.  The  aorta  and  bicuspid 
valves  were  somewhat  thickened  and  opaque.  The  lungs  and  organs  in  the  abdomen  were 
healthy. 


300  HUMAN    BRAIN. 

"In  the  brain  there  existed  considerable  sub-arachnoid  effusion,  and  fluid  was  found  in 
large  quantities  at  the  base ;  and  the  basilar  and  central  arteries,  and  their  divisions,  were 
extensively  ossified.  The  cerebral  substance  was  of  natural  firmness;  the  sections  were 
abundantly  sprinkled  with  red  dots.  Divided  into  small  sections,  and  examined  with  the 
greatest  care,  the  brain  displayed  no  trace  of  haemorrhage  or  softening,  unless,  perhaps,  the 
optic  thalamus  and  corpus  striatum  of  the  right  side  were  slightly  less  firm  than  the  same 
parts  of  the  opposite  side.  There  was  observed  nothing  unnatural  in  the  ventricles,  pons 
Varolii,  medulla  oblongata,  or  spinal  marrow ;  all  these  parts  retained  their  natural  firm- 
ness, and  the  only  striking  peculiarity  was  the  altered  condition  of  the  coats  of  the  various 
cerebral  arteries. 

"  In  this  report  I  have  purposely  retained  the  words  dictated  by  M.  Bouillaud  to  his  extern 
in  the  Post-mortem  Theatre,  to  show  that  every  care  was  taken  to  ascertain  the  state  of  the 
brain  and  spinal  cord;  and  that,  with  the  attention  specially  directed  to  the  central  portions 
of  the  right  hemisphere,  they  afforded  no  satisfactory,  or  even  probable,  evidences  of  soften- 
ing. Having  taken  portions  of  the  thalamus  and  corpus  striatum,  I  subjected  them  to  a 
careful  microscopic  examination,  and  obtained  very  characteristic  proofs  that  morbid  changes 
had  been  proceeding  in  these  parts  sufficient  to  account  for  the  symptoms  present  during 
life.  The  scarcely  softened  portions  of  the  right  thalamus  and  corpus  striatum,  though 
scarcely  more  tinged  with  blood  than  natural,  as  viewed  by  the  naked  eye,  were  found,  on 
microscopic  examination,  to  contain  numerous  blood  globules,  and  the  tubes  were  much 
broken  up;  along  the  sides  of  the  capillary  vessels  the  small  exudation  granules  were  found 
extensively  extravasated,  and  occasionally  there  existed  in  the  adjacent  cerebral  tissue  the 
large  round  clusters  of  granules,  to  which  the  terms  exudation  corpuscles,  and  masses,  have 
been  applied.  The  exudation  was,  however,  chiefly  in  the  granular  form,  and  confined  to 
the  sides  of  the  vessels,  and  thus  corresponded  with  the  very  slight  amount  of  softening  pro- 
duced. The  granules  were  found  in  portions  of  the  corpus  striatum  and  thalamus  opticus, 
which  were  far  from  any  appearance  of  softening. 

"  The  report  of  the  microscopic  appearances  in  this  case,  and  which  so  fully  confirmed  the 
correctness  of  the  diagnosis  formed  during  life,  I  had  the  pleasure  of  communicating  to  M. 
Bouillaud,  through  his  Chef  de  Clinique,  M.  Lemaire. 

"The  second  case  occurred  in  my  own  practice  more  recently ;  it  is  as  follows: — 

"  Case  II. — John  Fletcher,  set.  62,  a  porter,  admitted  into  the  Royal  Free  Hospital,  August 
the  15th,  1846.  He  stated  that  he  had  lived  very  freely  for  the  last  14  years,  but  enjoyed 
good  health  till  about  a  month  before  his  admission.  He  then  began  to  suffer  from  breath- 
lessness,  cough,  and  swelling  of  the  extremities,  more  particularly  of  the  legs,  and  latterly  of 
the  abdomen.  When  admitted,  he  complained  of  difficulty  of  breathing,  but  had  no  pain  in 
the  chest;  he  had  a  severe  cough,  and  expectorated  some  frothy  mucus.  The  body  was 
generally  anasarcous,  and  the  abdomen  tumid,  and  fluctuated  on  percussion.  The  tongue 
was  covered  with  a  brown  fur ;  the  pulse  was  88,  and  tolerably  resistent ;  the  respirations 
28,  short  and  labored.  The  urine  acid,  very  albuminous,  and  of  a  deep  brownish  red  color; 
in  quantity  it  amounted  to  three  pints  during  the  twenty-four  hours.  The  chest  sounded 
generally  dull  on  percussion,  both  before  and  behind ;  but  it  was  relatively  less  resonant  in 
the  right  side,  towards  the  lower  part.  The  respiration  was  throughout  feeble,  and  attended 
by  a  prolongation  of  the  expiratory  sound.  It  was  weaker  on  the  right  side,  and  absent  at 
its  lower  part.  The  respiration  was  generally  attended  with  sonorous  and  sibilant  rales, 
and  a  moist,  and  somewhat  small,  crepitation  was  heard  over  the  lower  part  of  the  back,  at 
each  side.  The  extent  of  the  cardiac  dullness  was  not  materially  increased.  The  action  of 
the  heart  was  regular,  the  sounds  nearly  inaudible,  from  the  loud  pulmonary  sounds ;  but, 
on  the  breath  being  held,  a  rough  and  grating  murmur  was  heard,  with  the  impulse  of  the 
heart,  over  the  whole  praecordia.  This  murmur  was  loudest  at  a  point  one  inch  below  the 
nipple,  but  it  was  also  distinct  between  that  body  and  the  sternum,  and  was  audible  over  the 
upper  third  of  the  sternum.  The  second  sound  was  heard  both  at  the  base  and  apex,  and 
was  grating  and  rough  in  its  character,  but  was  unattended  by  murmur.  On  the  22d  he 
complained  of  much  pain  in  the  region  of  the  heart,  and  there  was  increased  difficulty  of 
breathing;  deep  brown-colored  expectoration,  occasionally  bloody  ;  great  lividity  of  face,  and 
very  scanty  secretion  of  urine :  during  the  whole  period  he  was  in  the  hospital  he  had  been 
in  a  state  of  great  mental  torpor,  with  muttering  delirium,  though  rational  when  aroused  ;  the 
tendency  to  coma  now  increased,  he  breathed  stertorously,  became  entirely  insensible,  and 
died  on  the  morning  of  the  26th  of  August. 

"The  body  was  examined  at  4  P.M.  the  same  day. 

"The  right  side  of  the  chest  and  the  cavity  of  the  abdomen  contained  much  deep  amber- 
colored  serum.  Both  lungs  were  very  sparingly  crepitant,  and  exuded  much  serurn  on  com- 
pression, especially  the  right,  which  was  much  compressed.  The  bronchi  were  dilated;  the 
tubes  filled  with  glairy  mucus,  and  the  mucous  membrane  reddened.  The  heart  was  very 
large,  weighing  one  pound  (avoirdupois) ;  it  was  much  overlapped  by  the  left  lung.  The 


RAMOLLISSEMENT.  301 

serous  coverings  were  coated  by  a  thin  and  very  soft  layer  of  lymph.  The  right  ventricle 
was  hypertrophied  and  much  dilated.  The  left  ventricle  very  large,  and  its  walls  greatly 
increased  in  thickness.  The  aorta  orifice  was  small,  and  the  valves  much  ossified  at  their 
attachments,  and  a  mass  of  atheroma  projected  between  the  angles  of  the  right  and  posterior 
crescents.  The  valves,  though  probably  competent,  had  evidently  formed  an  obstruction  to 
the  passage  of  the  blood  from  the  ventricle.  The  mitral  valve  was  also  thickened,  and  its 
aperture  somewhat  contracted.  It  had  a  hard  atheromatous  mass  projecting  from  the  right 
extremity  of  its  folds.  The  auricles,  especially  the  right,  were  large.  The  aorta  displayed 
much  atheromatous  thickening,  and  the  orifices  of  the  coronary  arteries  were  surrounded  by 
deposit,  but  not  materially  strictured.  The  chylopoietic  organs  were  congested;  the  kidneys 
were  somewhat  granular;  the  proper  coat  adherent. 

"The  brain  weighed  39f  oz.  (avoirdupois). 

"  There  existed  much  fluid  in  the  sub-arachnoidal  cellular  membrane,  in  the  cavity  of  the 
ventricles,  and  at  the  base.  The  convolutions  on  the  superior  surface  of  the  hemispheres 
were  very  narrow,  convex,  and  widely  separated  from  each  other;  the  pia  mater  was  very 
readily  removed  from  them.  This  atrophy  of  the  convolutions  was  most  marked  at  the  upper 
surface  of  the  anterior  lobes,  and  here  there  existed  patches  of  softening  of  the  surface,  as 
also  at  the  under  surface  of  the  anterior  and  middle  lobes.  The  softened  portions  were  of  a 
deep  amber  color,  and  occupied  chiefly  the  convexities  of  the  convolutions.  The  softening 
seemed  to  have  commenced  on  the  free  surface  of  the  gray  matter,  so  that,  on  removing 
the  pia  mater,  a  portion  of  the  altered  tissue  adhered  to  it,  and  a  furrow  was  exposed,  filled 
by  a  diffluent  pulp.  In  some  places  the  surfaces  of  the  convolutions  were  only  slightly 
abraded:  in  others  the  softening  involved  the  whole  thickness  of  the  cortical  substance;  but 
in  none  did  the  change  appear  to  implicate  the  subjacent  medullary  matter.  The  gray  matter 
of  the  brain  for  some  distance  around  the  patches  of  softening  was  of  a  hard  and  almost 
horny  consistence,  had  a  peculiar  semi-transparent  appearance,  and  was  of  a  leaden  hue. 
The  softened  matter,  when  more  minutely  examined,  was  found  to  consist  of  a  diffluent  or 
fluid  portion,  readily  miscible  with  water,  and  a  more  solid  material  of  a  deep  amber  color, 
of  the  consistence  of  firm  gelatine,  and  only  admitting  of  being  broken  down  with  difficulty. 
The  former,  examined  by  the  microscope,  consisted  of  broken  down  cerebral  substance,  with 
capillary  vessels  having  exudation  granules  on  their  sid«s,  and.  a  few  exudation  corpuscles 
mixed  with  the  cerebral  substance.  The  latter  was  composed  of  little  else  than  dense  masses 
of  aggregated  granules  of  exudation.  Both  materials  were  intermixed  with  free  oil  globules, 
and  contained  tabular  crystals,  apparently  of  cholesterine. 

"  On  the  free  surfaces  of  the  corpora  striata,  in  each  ventricle,  there  existed  patches  of 
softening.  The  cerebral  substance  was  in  these  almost  diffluent,  but  retained  its  natural  hue, 
and,  when  subjected  to  the  microscope,  was  found  to  present  no  other  peculiarity  than  being 
mixed  with  an  unusual  proportion  of  fluid,  and  the  tubes  broken  up  and  separated.  There 
was  no  evidence  of  exudation. 

"  The  various  cerebral  arteries  were  covered  with  atheromatous  matter,  but  to  a  less  ex- 
tent than  is  frequently  seen  in  elderly  persons. 

"  In  this  instance  the  brain  presented  two  very  different  forms  of  softening— the  one,  in- 
volving very  extensively  the  gray  matter  of  the  convolutions,  was  evidently  inflammatory  in 
its  origin;  the  other,  affecting  the  surfaces  of  the  corpora  striata,  was  most  probably  the  result 
of  postmortem  changes.  These  inferences  accord,  it  will  be  observed,  with  the  symptoms 
present  during  life.  The  previous  history  of  the  patient  was  not  ascertained :  he  was  brought 
into  the  hospital  in  a  state  of  destitution,  and  presented  at  that  time,  as  well  as  afterwards, 
great  mental  hebetude,  with  partial  delirium,  gradually  lapsing  into  complete  coma;  the  dis- 
turbance of  the  intellectual  functions  which  chronic  disease  of  the  gray  matter  of  the  brain 
would  be  expected  to  induce.  On  the  other  hand,  he  had,  throughout  his  illness,  no  convuls- 
ive attack  or  paralysis ;  which  would  have  existed  had  the  central  softening  resulted  in  a 
morbid  process;  and  which,  we  have  seen,  was  present  in  the  first  case,  though  the  change 
in  the  corpus  striatum  was,  to  the  naked  eye,  much  less  obvious. 

"The  inflammatory  softening  of  the  gray  matter  of  the  brain  was,  in  this  case,  probably 
of  considerable  duration.  The  deep  amber  color  of  the  softened  portions,  the  darkness  and 
induration  of  the  surrounding  cineritious  matter,  and  the  dense,  opaque,  and  irregular  masses 
of  exudation,  found  on  microscopic  examination,  correspond  with  what  I  have  observed  in 
several  other  cases  of  chronic  softening  of  the  surface  of  the  brain,  and  exist  to  a  less  degree 
in  cases  of  chronic  softening  of  the  medullary  substance.  The  dark  color  of  the  softened 
portions  and  the  density  and  large  size  of  the  exudation  masses,  are,  I  believe,  characteristic 
of  the  slower  forms  of  cerebral  softening-. 

"  The  changes  undergone  by  the  surfaces  of  the  corpora  striata  in  this  case  are  also  charac- 
teristic of  the  most  frequent  form  of  what  is  believed  to  be  post-mortem  softening;  and  the 
case  affords  an  example  of  the  circumstances  under  which  this  change  most  frequently  occurs. 
The  softening  appears  to  be  dependent  on  infiltration  of  the  serum,  effused  into  the  ventricles 


302  HUMAN    BRAIN. 

and  the  adjacent  cerebral  substance;  and  the  appearances  presented  on  microscopic  exami- 
nation are  such  as  would  thus  result.  I  have  many  times  observed  this  state,  and  have  no- 
ticed its  various  stages,  from  a  degree  of  infiltration  producing  only  a  sudden  appearance  of 
portions  of  the  boundaries  of  the  ventricles,  to  the  complete  destruction  of  extensive  portions 
of  the  corpora  striata,  thalamus,  fornix  and  septum,  forming  a  thick  milky  pulp,  floating  in 
the  ventricular  cavity.  This  extensive  softening  I  have  seen  unattended  by  any  symptoms 
of  paralysis  or  contraction  during  life,  as,  were  it  produced  before  death,  could  certainly  not 
be  the  case.  It  is  generally,  however,  if  not  always,  found  in  cases  of  very  copious  effusion 
from  acute  inflammation,  and  is  especially  common  after  the  arachnitis  of  children.  The 
production  of  the  softening  is,  therefore,  probably  aided  by  a  slight  extension  of  disease  from 
the  inflamed  serous  membrane  to  the  parts  beneath,  analogous  to  the  slight  change,  which , 
in  cases  of  pleurisy  or  pericarditis,  affects  the  portions  of  the  substance  of  the  lungs  and 
heart  contiguous  to  the  serous  membrane. 

"In  cases  of  extensive  chronic  effusion  into  the  ventricular  cavities,  the  parts  around  are 
most  frequently  indurated,  as  we  find  in  the  cases  of  serous  effusion  after  chronic  insanity, 
after  death  from  diseases  attended  with  great  emaciation,  and  in  persons  who  die  at  an  ad- 
vanced period  of  life. 

"  There  is  another  remark  which  suggests  itself  in  reference  to  these  cases :  both  were,  it 
will  be  observed,  elderly  persons,  the  one  originally  of  feeble  constitution,  and  debilitated; 
the  other  exhausted  by  organic  disease  in  two  other  organs :  in  both,  the  arteries  of  the  brain 
were  diseased,  and  in  the  last  the  softening  involved  extremely  different  portions  of  the  sur- 
face of  the  brain.  They  were,  therefore,  both  persons  in  whom  the  form  of  softening,  re- 
garded by  Rostan  and  Recamin  as  non  inflammatory,  might  have  been  expected  to  be  found  ; 
yet,  in  each  case,  microscopic  examination  of  the  diseased  portions  afforded  conclusive  evi- 
dences of  the  presence  of  inflammation.  The  inference  which  thus  suggests  itself  is  sup- 
ported by  several  other  cases  I  have  had  the  opportunity  of  observing,  and  I  cannot  but 
regard  the  views  of  these  pathologists  as  doubtful. 

"  The  importance  of  the  color  of  softened  portions  of  the  brain,  as  affording  the  means  of 
distinguishing  the* nature  of  the  change,  has,  I  believe,  been  overrated;  and  while  it  is  pro- 
bable, that  all  cases  of  softening  of  some  duration  will  be  found  to  present  decided  changes 
of  color,  referable  either  to  the  engorgement  of  the  part  with  blood,  to  slight  sanguineous 
extravasation,  or  to  the  color  of  the  exuded  material,  we  have  evidenced,  in  the  first  case,  that 
inflammatory  softening  may  prove  fatal  without  the  tissue  having  undergone  any  alteration 
of  color.  The  difference  between  the  processes  of  cerebral  softening  in  persons  at  early  and 
advanced  periods  of  life  I  regard  as  perfectly  analogous  to  those  which,  under  similar  cir- 
cumstances, affect  other  forms  of  diseased  action." 

Atrophy  of  the  Brain. — There  is  no  doubt  that  the  brain,  either  as  a 
whole  or  in  part,  becomes  atrophied,  though  more  frequently  the  latter. 
It  may  arise  from  arrest  of  development  in  the  foetal  state.  The  anen- 
cephalous  foetus  is  the  most  complete  illustration  of  this  form  of  atrophy. 
Sometimes  the  arrest  of  development  is  confined  to  the  hemispherical 
ganglion,  and  then  the  brain  retains  the  same  condition  permanently, 
which,  in  a  normal  state,  would  be  merely  one  of  its  stages  of  growth. 
There  is  an  excellent  account  of  this  disorder,  with  illustrations,  in 
Cruveilhier's  Morbid  Anatomy. 

Cruveilhier  describes  another  form  of  atrophy  as  resulting  from  the 
pressure  of  serous  effusion  into  the  ventricles  in  childhood ;  but  this  I 
consider  does  not  deserve  to  be  considered  as  a  true  case  of  atrophy ; 
it  is  in  reality  simply  a  case  of  chronic  hydrocephalus  in  childhood, 
which,  causing  a  dilatation  of  the  left  lateral  ventricle  at  the  expense  of 
the  tubular  portion  of  the  hemispheres,  has  been  partially  absorbed,  and 
hence  the  paralysis.  The  hemispherical  ganglion  or  cortical  substance 
was  neither  atrophied  nor  absorbed,  but  in  normal  quantity,  as  demon- 
strated by  the  section,  and  the  rugae  on  the  surface  were  much  more 
numerous  on  that  side,  and  hence  the  preservation  of  the  intellect. 

A  third  form  is  that  which  follows  chronic  inflammation  of  the  hemi- 
spherical ganglion;  we  often  meet  with  it  in  the  brain  of  old  standing 
cases  of  insanity,  where  the  patient  has  sunk  into  a  complete  state  of 


HYPER.EMIC    AFFECTIONS    OF    THE    BRAIN.  303 

fatuity.  The  convolutions  are  then  narrow  and  pinched,  almost  sharp, 
instead  of  being  flat  and  rounded,  full  and  plump.  In  some  cases  the 
ganglion  is  actually  thinner,  as  may  be  seen  on  section.  A  fourth  is 
simple  senile  atrophy.  In  very  old  age  the  brain,  like  other  organs,  is 
less  perfectly  nourished,  and  like  other  organs,  shrinks  in  bulk.  The 
wide  fossaB  between  the  two  convolutions  are  filled  with  that  beautiful 
protector,  the  cerebro-spinal  fluid  :  for  in  these  cases  the  excess  of  this 
fluid  is  not  to  be  regarded  as  morbid  ;  it  is  the  cushion  which  nature  has 
kindly  provided  to  supply  the  deficiency  of  brain.  Still  it  must,  I  think, 
be  allowed  that  the  brain  of  old  people  is  more  exposed  to  injury  from 
external  violence  than  the  adult.  This  I  conceive  arises  from  its  being 
more  easily  shaken  in  its  case.  It  is  only  upon  such  a  supposition  that 
we  can  account  for  those  instances  of  laceration  of  the  brain  from  a 
blow  on  the  skull  unaccompanied  with  fracture,  an  accident  which  is 
comparatively  rare  in  the  younger  subject.  The  following  case  I  have 
selected  from  among  others  as  a  good  illustration  of  the  accident: — 

Case  10. — Elizabeth  Swannell,  set,  69,  a  cook,  was  admitted,  under  the  care  of  Mr.  Green, 
into  Elizabeth's  ward,  St.  Thomas's  Hospital,  on  the  24th  of  February,  1841,  at  half-past  four, 
P.M.,  having  received  a  large  contused  wound  which  exposed  the  bone  over  the  right  eye- 
brow. No  fracture  or  further  external  injury  could  be  detected.  Symptoms  on  admission  :•' — 
Perfectly  insensible  and  motionless;  left  pupil  very  much  contracted  and  fixed,  the  swelling 
of  the  surrounding  part  preventing  the  state  of  the  right  from  being  ascertained;  breathing 
labored,  with  a  stertorous  noise;  pulse  96,  full,  and  not  easily  compressed;  extremities  mo- 
derately warm ;  faeces  and  urine  involuntarily  passed ;  great  rigidity  of  the  muscles,  especially 
of  the  right  arm  and  left  leg;  frothy  saliva  issuing  from  the  mouth;  no  spirituous  odor  could 
be  detected  in  the  breath. 

History. — Shortly  after  two  o'clock,  while  going  down  stairs,  she  suddenly  fell,  and  was 
picked  up  exactly  in  the  same  state  in  which  she  was  brought  to  the  hospital.  Was  not 
subject  to  fits.  Nobody  saw  the  accident. 

Treatment, — A  surgeon  had  bled  her  in  the  left  arm  previous  to  admission.  Soon  after  she 
was  brought  in,  she  was  cupped  to  ijix  from  the  nape  of  the  neck,  a  large  blister  was  applied 
to  the  back  part  of  the  head,  which  was  shaved,  and  hot  water  applied  to  her  feet.  Breath- 
ing slightly  relieved  by  cupping;  pulse  continues  full,  and  at  92.  At  nine  o'clock,  I  saw  her, 
with  Mr.  B.  Travers,  apparently  exactly  in  the  same  state,  except  that  her  pulse  varied  in 
frequency  from  76  to  92;  it  was  very  full,  but  did  not  indicate  sufficient  strength  to  bear 
further  loss  of  blood ;  the  breathing  was  not  quite  so  labored.  At  1 1  o'clock  I  gave  her 
grs.  viij.  of  calomel. 

Feb.  25th,  9  A.M. — No  improvement  in  respect  of  sensation  or  motion :  pupil  contracted 
and  fixed :  pulse  90,  and  full,  breathing  a  little  impeded  by  mucus,  much  frothy  saliva  issu- 
ing from  the  mouth.  She  remained  exactly  in  the  same  state,  her  pulse  continuing  full,  and 
about  90,  till  within  two  or  three  minutes  of  her  death,  which  took  place  at  10  minutes 
past  4  P.M. 

Post-mortem. — The  brain  did  not  seem  to  fill  the  skull  completely.  No  morbid  appear- 
ance on  the  surface  of  the  brain.  Tentorium  smeared  with  blood.  Interior. — Extensive 
effusion  of  blood  into  the  left  ventricle ;  some  into  the  right :  this  effusion  appears  to  have 
resulted  from  laceration  of  the  left  corpus  striatum  and  thalamus,  also  those  fibres  of  the 
great  commissure  which  form  the  anterior  part  of  the  roof  of  the  left  ventricle.  The  lace- 
rated corpus  striatum  and  thalamus  were  forced  into  the  right  ventricle  under  the  fornix, 
and,  when  first  observed,  looked  almost  like  a  medullary  tumor  with  an  ulcerated  surface. 

In  this  case  the  brain  appears  to  have  been  lacerated  by  the  "  centre  coup,"  to  which  it 
was  especially  exposed  from  its  diminished  size,  in  relation  to  its  containing  cavity,  the 
result  of  senile  atrophy. 

Hypertemic  Affections  of  the  Brain. — From  the  an&mic  affections  let 
us  now  direct  our  attention  to  the  hypersemic.  First,  the  inflammatory. 

These  may  be  divided,  for  the  sake  of  convenience,  into  the  following 
heads : — 

Inflammation  of  the  Brain  from  without: 

1.  Inflammation  of  the  brain  from  concussion.     2.  Inflammation  of 


304  HUMAN    BRAIN. 

the  brain  consequent  upon  and  continuous  with  inflammation  of  its  pro- 
tective apparatus,  viz.,  the  pericranium,  the  cranium,  and  the  cerebral 
membranes,  whether  caused  by  injuries,  local  diseases,  or  constitutional 
diseases. 

Inflammation  of  the  brain  consequent  on  metastasis,  such  as  the  re- 
trocession of  an  eruption,  &c. 

Inflammation  of  the  Brain  from  within  : 

Inflammation  of  the  brain  from  over  action,  mental  emotions,  sudden 
fright,  &c. 

Inflammation  of  the  brain  is  a  wide  subject,  for  the  brain,  unlike  the 
liver,  lungs,  kidneys,  &c.,  is  not,  as  we  have  seen,  a  single  instrument 
performing  one  office.  It  is  made  up  of  many  instruments,  each  having 
its  individual  function  to  perform.  The  symptoms  of  the  disease  will 
therefore  vary  according  to  the  portion  which  is  diseased.  It  is  true, 
that  all  the  ganglia  within  the  skull  are  so  closely  united  that  any  single 
ganglion  can  scarcely  be  affected  without  the  rest  sympathizing.  Still 
inflammation  is  sometimes  restricted  and  the  symptoms  peculiar. 

I  believe,  1st.  That  inflammation  of  the  hemispherical  ganglion  may 
be  distinguished  from  inflammation  of  the  rest  of  the  encephalon.  2dly. 
That  inflammation  of  the  upper  portion  of  this  ganglion  may  be  distin- 
guished from  that  inflammation  which  is  at  the  base  of  the  brain.  3dly. 
That  inflammation  of  the  medullary  or  tubular  substance,  though  seldom 
occurring  alone,  may  be  distinguished  from  that  of  the  ganglia.  4thly. 
That  inflammation  of  the  cerebellum  has  its  characteristics. 

The  most  important  portion  of  the  brain,  as  regards  our  relation  to 
the  external  world,  is  the  hemispherical  ganglion  or  cortical  substance. 
From  its  exposed  position  this  ganglion  is  that  portion  of  the  brain  which 
is  most  frequently  disordered  and  diseased.  It  will  be  well  to  consider, 
first,  what  morbid  changes  it  is  liable  to,  their  consequences  and  termi- 
nations, and  afterwards  review  the  various  circumstances  which  may 
give  rise  to  them,  such  as  disease  and  injuries  of  the  skull  and  mem- 
branes, &c.  &c.  Inflammation  of  the  hemispherical  ganglion  is  usually 
described  by  authors  as  inflammation  of  the  membranes  of  the  brain — 
meningitis — overlooking  entirely  the  more  important  organ  affected. 
This  will  be  adverted  to  again. 

I  am  afraid  that  in  many  cases  the  post-mortem  appearances  of  menin- 
gitis are  not  always  detected.  There  is  no  doubt  that  it  is  often  difficult 
in  many  cases  to  decide  after  death  whether  there  has  been  any  undue 
vascularity  of  the  pia  mater  during  life.  The  position  in  which  the 
head  has  been  placed  after  death  in  relation  to  the  body,  should  always 
be  attended  to,  for  if  the  examination  is  shortly  after  death,  the  blood 
still  fluid,  and  the  head  hanging  down,  the  cerebral  vessels  are  sure  to 
be  full.  On  the  other  hand,  if  the  head  has  been  raised,  and  the  chest 
opened  before  the  head,  and  the  great  vessels  of  the  heart  divided,  so 
that  a  large  quantity  of  the  blood  escapes,  the  meningeal  vessels  which, 
during  life,  had  been  over-filled  with  blood,  may  be  unloaded  and  empty. 
Still  it  will  be  found  that  these  accidental  circumstances  affect  the  larger 
vessels  rather  than  the  capillaries.  The  morbid  appearances  of  the  arach- 
noid which  indicate  the  existence  of  inflammation,  cannot  be  so  easily 
affected.  These  are — First,  Opacity.  It  is  true  that  this  is  a  very  com- 


HYPER-EMIC   AFFECTIONS   OF    THE    BRAIN.  305 

mon  appearance,  but  still  it  is  one  which  I  believe  all  pathologists  agree 
in  considering  the  result  of  chronic  inflammation.  Secondly.  Dryness 
of  the  arachnoid.  This  is  by  no  means  common,  but  I  quite  agree  with 
Dr.  Bright  in  saying,  "In  many  cases  of  high  cerebral  irritation,  and 
where  we  have  reason  to  suspect  actual  inflammation,  this  app?arance 
occurs ;  and  there  is  no  reason  to  doubt  that  in  this  membrane,  as  in 
others,  a  defective  secretion  is  amongst  the  well-marked  signs  of  inflam" 
mation."  Thirdly.  Effusion  of  lymph  and  fibrine  are  proofs  of  inflam- 
matory action. 

The  effect  of  inflammation  on  the  hemispherical  ganglion,  in  producing 
morbid  alterations  of  structure,  depends  much  on  the  intensity  of  the 
inflammation,  and  its  duration. 

The  appearance  which  it  presents  after  death,  will  vary  according  to 
the  time  at  which  death  occurs  in  relation  to  the  occurrence  of  the  at- 
tack. These  alterations  may  be  divided  into  alterations  in  consistency 
and  alterations  in  color.  >,Jj 

Thus  there  are  softening  and  hardening.  In  regard  to  color,  the  changes 
are  very  striking.  In  health,  the  color  varies  a  little,  but  the  variation 
is  slight.  The  natural  color  may  be  closely  imitated  in  water  colors,  by 
mixing  light  red  and  Indian  red  ;  it  is  difficult  to  describe  it  in  words. 
Dr.  Bright  has  called  it  "  a  light  fawn-colored  brown." 

In  disease  the  color  varies  from  a  pale  tint,  scarcely  darker  than  the 
medullary  substance,  up  to  an  intense  purple  ;  occasionally  it  assumes  a 
bright  scarlet ;  but  we  seldom  have  the  opportunity  of  seeing  it  in  this 
state,  for  it  is  the  result  of  active  inflammation,  and  patients  seldom  die 
during  this  stage  of  the  disease. 

For  some  time,  I  took  every  opportunity  of  making  a  colored  drawing 
of  the  cortical  substance,  or  hemispherical  ganglion,  of  all  patients  in*- 
discriminately  that  I  could  examine  after  death  ;  at  this  time  I  went  a 
great  deal  to  Hanwell,  and,  through  the  kindness  of  that  noble  bene- 
factor of  his  fellow  creatures,  Dr.  Conolly,  I  had  many  opportunities  of 
examining  the  brains  of  the  insane. 

The  general  result  of  my  observations  was,  that  a  pale  condition  of 
this  ganglion  was  almost  invariably  found  in  patients  who  had  sunk  into 
a  state  of  mental  imbecility,  and  was  generally  associated  with  some 
serous  effusion  and  thickening  of  the  arachnoid  and  pia  mater. 

In  patients  who  had  been  long  inmates  of  the  asylum,  and  in  whom 
the  disease  had  ebbed  and  flowed,  sometimes  producing  high  excitement, 
and  sometimes  depression,  I  often  found  a  mottled  appearance. 

The  following  abstract,  from  the  details  of  a  case  noted  at  the  time, 
will  explain  what  I  mean  : — 

Case  11. — Mania,  Hanwell,  April  23d,  1842.  Thomas  Griffiths  was  admitted  on  the  16th 
March,  1842;  he  was  violent  and  refractory,  but  not  showing  any  disposition  to  injure  any 
one;  very  sleepless,  opiates  having  very  little  effect  upon  him;  never  slept  for  more  than 
two  hours  at  a  time;  pulse  always  low,  arid  general  indications  of  debility,  suppuration 
taking  place  from  slight  causes.  The  skin  sloughing  from  the  smallest  injuries. 

The  day  before  his  death,  he  was  quite  tranquil,  not  rational,  but  simply  quiet  and  ex» 
hausted.  These  particulars  I  obtained  from  Dr.  Begley. 

Post-mortem. — Skull. — Sero-sanguineous  etlusion  into  the  sac  of  arachnoid.  Arachnoid 
•white,  thick,  and  opaque.  Pia  mater  rather  more  than  normally  vascular.  Hemispherical 
ganglion  decidedly  more  vascular  than  in  health,  but  not  much  darker.  This  increased, 

20 


306  HUMAN   BRAIN. 

vascularity  was  so  irregular,  that  the  patches  gave  the  ganglion  a  mottled  appearance  of  purple 
red  color.     Serum  in  the  ventricles  clear,  but  quantity  increased. 

A  bright  rose-colored  tint  is  sometimes  met  with,  and  always  indicates 
that  there  had  been  increased  vascular  action  during  life.  This  color 
may  be  seen  both  on  section,  and  on  the  surface  after  the  removal  of  the 
arachnoid  and  pia  mater.  The  different  layers  which  compose  this 
ganglion  are  sometimes  unusually  distinct ;  but  I  have  not  been  able  to 
associate  this  appearance  with  any  peculiar  symptoms  during  life. 

Dr.  Bright  says*  that "  a  rose  tint  is  sometimes  peculiarly  distinct  on  the 
inner  layer,  sometimes  confined  by  a  distinct  line  of  separation  from  the 
outer  part  of  the  cineritious  substance,  at  other  times  imperceptibly 
shading  into  it.  The  one  division  between  the  layers  is  sometimes 
marked  by  different  shades  of  the  habitual  color,  or  sometimes  by  dark 
gray  shades  from  venous  congestion,  or  by  the  unusual  pinkness,  either 
of  the  external  or  the  internal  layers.  There  are  usually  three  layers, 
thus  pretty  distinctly  marked,  though  occasionally  the  eye  is  capable 
of  distinguishing  six.  It  is  not  at  all  uncommon  to  find  a  certain 
tendency  to  separate  in  the  external  layer ;  but  this  is  occasionally  so 
marked  in  elderly  persons,  and  in  those  who  have  labored  under  symp- 
toms of  imbecility,  as  to  be  obviously  a  morbid  state.  In  these  cases, 
when  the  membranes  have  been  drawn  off,  if  a  convolution  be  gently 
pinched  between  the  finger  and  thumb,  a  considerable  portion,  of 
about  the  thickness  of  a  wafer  or  more,  but  uniform  in  its  depth,  comes 
away,  leaving  an  even  surface.  This  state  of  the  cineritious  substance 
has  appeared  to  me  sometimes  to  be  the  result  of  habitual  excess  in  fer- 
mented liquors,  and  is  likewise  found  where  febrile  diseases  have  been 
accompanied  with  delirium  and  tremor.  Although  this  condition  of  the 
cineritious  substance  is  by  no  means  uncommon,  I  do  not  know  of  any 
author  who  has  referred  to  it,  except  Dr.  Foville." 

Cineritious  substance  is  often  found  of  a  gray  color,  approaching  in 
some  cases  to  a  deep  violet  color.  Dr.  Bright  attributes  it  to  venous 
congestion,  and  considers  that  it  is  sometimes  increased  by  the  morbid 
condition  of  the  blood,  produced  by  its  imperfect  decarbonization. 
"The  vessels,  filled  with  dark  blood,  may  often  be  distinctly  seen  by 
the  assistance  of  a  lens,  and  the  numerous  orifices,  by  which  they  have 
communicated  with  the  pia  mater,  may  be  seen,  of  unusual  size,  upon 
the  surface  of  the  convolutions.  This  state  is  usually  attended  with 
decided  symptoms  of  congestion,  and  of  cerebral  oppression  during  life; 
it  is  occasionally  the  result  of  fevers,  particularly  when  they  are  accom- 
panied with  obstruction  in  the  lungs.  In  cases  of  bronchitis,  in  diseases 
of  the  heart  which  greatly  obstruct  the  circulation,  and,  in  cases  where 
suffocation  has  produced  death,  we  find  this  gray  appearance  of  the 
cineritious  substance." 

The  cineritious  substance  is  sometimes  of  a  yellow  color,  but  I  have 
never  seen  this,  except  in  connection  with  an  alteration  in  the  color  of 
the  medullary  substance,  and  I  believe  it  to  result  from  an  extension  of 
disease  from  the  medullary.  I  have  seen  the  change  in  the  latter  alone. 

The  change  in  texture,  as  regards  softening,  varies  in  degree  from 

•  Reports  of  Medical  Cases,  vol.  ii.  p.  677. 


INFLAMMATION   OF   THE   HEMISPHERICAL   GANGLION.  307 

»  % 

that  slight  change  which  is  only  observable  in  consequence  of  its  being 
torn  off  in  small  patches,  or  the  removal  of  the  pia  mater,  and  a  soft, 
pulpy  state  like  thick  cream.  Sometimes,  though  seldom,  it  is  most 
unnaturally  hard.  Dr.  Bright  has  associated  this  state  with  old  inflam- 
matory mischief  of  the  part,  as  thickening  or  adherence  of  the  membranes. 

I  have  occasionally  met  with  laceration  of  this  ganglion,  which  Dr. 
Bright  was  the  first  to  point  out  as  one  of  the  effects  of  concussion.  It 
shows  itself,  says  this  author,  "  in  two  ways:  by  small  ecchymoses  of 
clots  in  the  cineritious  substance,  which  are  often  found  in  various  parts 
at  the  same  time  ;  or  by  an  abrasion  of  the  surface,  which  is  thus  re- 
duced to  a  pulpy  state  mixed  up  with  bloody  points,  giving  the  idea  that 
the  mischief  has  in  part  resulted  from  the  tearing  off  of  the  pia  mater. 
Convulsion  of  the  features,  and  of  the  extremities  of  the  opposite  side, 
is  the  frequent  symptom  attendant  upon  this  lesion." 

The  hemispherical  ganglion  is  sometimes  very  thin  over  the  whole 
cerebrum  or  cerebellum;  '*  but  besides  that,"  says  Dr.  Bright,  "  I  have 
seen  it  almost  wanting  over  a  small  space,  where  a  layer  of  lymph  has 
been  thrown  out  between  the  pia  mater  and  the  convolutions.  In  one 
or  two  instances  I  have  also  seen  a  clean  excavation  in  the  convolutions, 
as  if  some  portion  previously  injured  or  diseased  had  been  absorbed." 

Symptoms  and  Effects  of  Inflammation  of  the  Hemispherical  Ganglion. 
—We  will  next  consider  attentively  one  of  the  most  important  laws  of  vital 
action  which  pathology  has  yet  unfolded  in  relation  to  the  nervous  system, 
namely,  that  the  first  effect  of  the  first  stage  of  inflammation  of  neurine 
is  to  excite  and  to  exalt  to  an  unnatural  degree,  exactly  the  same  kind 
of  power  which  we  have  reason  to  believe  resides  in  it  in  a  normal  state. 
For  instance,  the  first  effect  of  inflammation  of  the  surface  of  the  brain 
is  to  excite  the  mental  faculties,  to  produce  great  irritability  of  temper, 
and  constant  restlessness  or  desire  for  action.  If  the  inflammation  be 
arrested  at  this  point,  the  patient  recovers  his  reason ;  but  if  it  pursues 
its  ravages  undisturbed,  limiting  its  destructive  effects  to  the  spot  where 
it  commenced,  without  extending  to  that  portion  of  the  brain  which  is 
beneath,  it  annihilates  the  intellect,  but  does  not  affect  the  muscular 
system;  while,  on  the  other  hand,  if  the  inflammation  extend  further, 
reaching  the  instruments  by  which  the  will  travels  to  the  muscles,  it 
first  produces  convulsive  action  in  these  muscles,  which  afterwards  be- 
come perfectly  paralytic  ;  in  this  case  the  integrity  of  the  neurine,  through 
which  volition  traversed  to  call  these  muscles  into  action,  is  compro- 
mised, and  its  power,  therefore,  as  an  instrument  for  the  production  of 
voluntary  motion,  destroyed. 

The  same  phenomena  are  presented  to  us  by  observations  on  the  in- 
struments of  sensation,  as  far  as  we  are  at  present  acquainted  with  these 
instruments,  for  we  generally  find,  when  inflammation  attacks  the  tract 
of  sensation,  (the  first  symptoms  existing  a  sufficiently  long  time  to  be 
accurately  observed,)  that  previous  to  the  obliteration  of  sensibility  in 
any  texture,  the  normal  sensibility  of  the  part  is  exalted,  the  patient 
suffering  the  most  severe  pain  both  at  the  spot  where  the  nerves  of  sen- 
sation originate,  and  in  the  brain  itself  where  they  terminate. 

The  first  effect  of  unusual  arterial  action  of  the  hemispherical  ganglion 
is  to  exalt  the  intellect;  this  effect  is  often  so  transient  that  it  may  be 


308          .*    :  ,  HUMAN   BRAIN. 

unobserved.  We  meet  with  a  good  illustration  of  it  in  the  effect  pro- 
duced  by  alcoholic  stimuli.  Up  to  a  certain  point  they  render  the  indi- 
vidual taking  them  lively  ;  his  ideas  come  more  rapidly  and  more  clearly  ; 
he  expresses  them  in  better  language,  with  greater  facility,  and  more 
rapidly;  but  this  effect  soon  passes  off.  If  the  stimulus  is  continued, 
the  brain  becomes  oppressed,  the  muscles  of  the  tongue  sluggishly  obey 
the  will,  and  the  speech  is  thick  and  indistinct;  his  ideas  are  confused, 
his  language  incoherent ;  at  last  he  loses  consciousness,  and  becomes 
wholly  insensible  to  the  external  world. 

As  these  views  are  based  on  a  belief  in  the  truth  of  the  two  following 
positions,  it  will  be  necessary  to  adduce  further  arguments  in  support  of 
them  : — 1st.  That  the  hemispherical  ganglia  are  intimately  connected  with 
the  intellectual  powers,  and  that  it  is  in  them  peculiarly,  and  not  in  the 
whole  cerebral  mass,  that  these  powers  reside.  2d.  That  the  medullary 
substance  beneath  is,  in  all  probability,  merely  the  passive  servant,  as  it 
were,  of  the  cineritious,  either  as  the  conductor  of  its  commands  to  the 
muscles,  or  of  the  materials,  namely,  the  various  impressions  made  on 
the  peripheral  extremities  of  the  nerves  of  sense,  which  the  cineritious 
perceives,  and  with  which  it  works. 

Such,  as  elsewhere  stated,  appears  to  be  the  opinion  of  MM.  Foville 
and  Pinel-Grandchamp,  and  such  also  is  the  opinion  of  Bouillaud,  who, 
when  investigating  the  localization  of  the  cerebral  functions,  says,*  "  If 
we  reflect  that  disturbance  of  the  intellect  can  exist  independently  of 
every  other  derangement  of  the  cerebral  functions  ;  if  we  reflect,  more- 
over, that  disturbance  of  the  intellect  appears  to  coincide  constantly  with 
an  alteration  of  the  cortical  substance  of  the  brain,  we  shall  be  obliged 
to  admit  as  very  probable  this  double  opinion,  namely,  that  the  injury 
of  the  intellect  depends  upon  that  of  a  distinct  part  of  the  cerebral  mass, 
and  that  the  distinct  part  of  the  brain  the  injury  of  which  produces  de- 
rangement of  the  intellect,  is  the  cortical  substance  of  that  organ."  He 
then  refers  to  the  following  cases  in  support  of  his  opinions. 

Case  12. — Alteration  of  the  intellectual  functions  without  lesion  of  the  locomotive  functions ;  then 
convulsions,  grinding  of  the  teeth,  loss  of  intelligence :  death  the  third  day.  Inflammation,  unth  soft- 
ening of  the  gray  substance,  arachnoiditis.^ — Maintion,  43  years  of  age,  house-painter,  married, 
entered,  the  18th  of  November  1823,  the  hospital  of  La  Charite:  six  years  ago  he  left  the 
military  service,  and  had  only  been  in  Paris  two  months.  Since  two  years  he  had  shown 
signs  of  imbecility,  and  had  completely  lost  all  memory.  Whilst  he  WHS  a  military  man, 
he  had  shown,  at  different  periods,  derangement  of  the  intellectual  faculties.  Last  year,  at 
Versailles,  he  had  symptoms  of  acute  meningitis:  two  months  ago,  these  same  symptoms 
having  re-appeared,  a  seton  was  inserted  in  the  nape  of  the  neck  :  besides,  for  two  years  he 
has  complained  of  constant  pain  of  the  head  and  at  the  root  of  the  nose,  with  a  smell  of 
putrefaction  in  this  cavity.  For  a  twelvemonth  he  has  been  weak  in  his  legs.  He  has  always 
had  a  good  appetite.  After  having  taken  cold  baths  for  a  month  when  he  was  in  the  hos- 
pital of  St.  Michel,  he  fell  in  a  state  of  great  exhaustion,  and  experienced  lipothymiae. 

The  17th  of  November  he  lost  his  mind,  had  repeated  attacks  of  convulsions,  with  loud 
and  unequal  respiration. 

The  18th,  at  ten  in  the  morning,  general  convulsions;  eyes  wandering;  white  froth  from 
the  mouth;  rigidity  of  the  limbs;  sometimes  grinding  of  the  teeth  and  contortion  of  the 
mouth  ;  sensibility  remaining  in  the  upper  extremities,  which  he  draws  back  when  pinched, 
and  makes  grimaces;  no  motion  in.  the  lower  extremities  when  pinched,  but  they  are  less 
rigid  than  the  upper.  Total  loss  of  intelligence;  respiration  rattling;  pulse  pretty  strong, 
full  regular  and  slow.  (Thirty  leeches  to  the  neck,  ice  to  the  head,  sinapisms  to  the  inferior  ex- 
trewities i  a  purgative  enema.')  The  agitation  continued  the  remainder  of  the  day;  the  convul- 

«0p.dt  f  OP- oil,  0«.  XV.  p.  88.  ;!;, 


INFLAMMATION    OF    THE    HEMISPHERICAL    GANGLION.  309 

sions  are  universal ;  the  face  is  red  and  tumefied,  the  mouth  is  deformed,  the  lips  projecting 
anteriorly.  With  the  ice,  the  head  is  exceedingly  hot ;  the  forearms  are  strongly  flexed ; 
intellect  is  entirely  lost.  He  was  in  the  same  state  during  the  night. 

The  1 9th,  in  the  morning,  the  right  arm  is  almost  without  motion,  the  left  alternately  rigid 
and  convulsed ;  eyes  shut ;  he  shuts  his  jaws  when  he  is  desired  to  drink,  and  appears  to 
feel  a  little  when  the  left  arm  is  pinched  very  hard:  slight  heat  of  skin ;  pulse  112,  full  and 
regular.  (Venaesect.  ad  £xij.  purgative  enema,  sinapisms,  &c.)  In  the  course  of  the  day 
the  patient  died  in  the  greatest  agony. 

Jlutops.  cadav. — twenty-four  hours  after  death.  The  arachnoid  is  adhering  in  eight  or  ten 
places  in  the  superior  surface  of  the  brain :  in  removing  it,  the  cortical  substance  comes 
away  with  it  in  pieces  of  about  the  size  of  a  franc,  and  about  a  line  in  thickness ;  the  me- 
dullary substance  is  a  little  injected.  The  left  lung  is  a  little  hard  posteriorly,  deprived  of 
air,  and  somewhat  hepatized.  The  right  is  red,  and  congested  in  about  the  same  place. 
The  mucous  membrane  of  the  stomach  is  red  in  its  splenic  portion.  All  the  other  organs 
are  healthy. 

Case  13. — Alteration  of  the  general  intellect  from  time  to  time,  loss  of  mind,  stupor  without 
paralysis  or  convulsions ;  erysipelas  of  the  face,  and  death. — Inflammation  and  softening  'of  the 
gray  substance,  with  injection  of  the  white  substance.* — Victoire,  46  years  of  age,  was  an  infirm 
patient  in  the  hospital  Saint  Louis  for  the  last  two  years.  She  was  subject  to  attarks  cha- 
racterized by  a  sudden  loss  of  mind,  convulsive  motions  of  the  lips,  and  an  embarrassment  of 
the  tongue  analogous  to  the  apoplectic  ;  it  was  observed  that  sensibility  was  almost  extinct. 
At  the  end  of  four  or  five  minutes  she  regained  her  senses ;  but  she  remained  as  if  it  were 
not  in  her  power  to  move ;  her  looks  were  fixed,  she  stammered, and  seemed  as  if  she  awoke 
from  a  lethargic  sleep.  She  completely  recovered  in  about  an  hour.  For  some  time  her 
courses  had  been  irregular;  eight  months  had  elapsed  since  they  had  made  their  appearance. 
During  this  time  the  attacks  just  described  became  more  frequent,  when  she  was  frequently 
bled  from  the  foot.  One  day  Victoire  fell  from  a  height  of  three  feet,  and  greatly  contused 
her  left  lumbar  region.  She  merely  applied  pressure  to  the  swelling.  After  a  time,  a 
phlegmon,  which  afterwards  formed  an  abscess,  made  its  appearance ;  the  abscess  was 
opened.  Shortly  after  another  swelling  was  formed  near  to  the  former:  it  was  also  opened; 
but  would  not  cicatrize.  The  first  wound  which  was  closed  soon  re-opened,  and  from  that 
time  a  very  large  quantity  of  pus  escaped  from  this  double  fistulous  ulcer.  She  was  desired 
to  keep  quiet ;  but  she  began  her  accustomed  work,  and  for  two  years  nothing  particular 
occurred. 

The  cerebral  symptoms  seemed  to  be  progressive.  Victoire  often  complained  of  headache, 
and  then  her  face  was  of  a  dark  red  color;  she  feh  some  pain  in  her  left  arm,  which  she 
said  wanted  strength.  Her  intellect  daily  got  worse';  more  stupefied;  when  spoken  to  she 
looked  like  an  idiot,  and  if  asked  whether  she  had  heard,  she  would  briskly  answer  Yesy 
without  any  other  emotion.  She  was  often  giddy,  and  she  often  seized  things  to  prevent 
herself  from  falling.  She  was  losing  strength,  the  circulation  languished,  the  breath  was  foul, 
the  appetite  little  altered.  With  all  these  inconveniences,  Victoire  fulfilled  her  services  as 
night-nurse  with  an  ardent  zeal.  Being  attacked  with  erysipelas,  she  was  obliged  to  take  to 
her  bed.  It  was  accompanied  with  great  heat,  and  proceeded  slowly.  It  was  oedernatous: 
two  grains  of  tartar  emetic  produced  abundant  vomiting ;  and  after  this  the  swelling  of  the 
face  abated.  The  secretion  of  the  lumbar  fistulas  also  ceased.  Little  attention  is  paid  to  this 
phenomenon:  three  ounces  of  manna  are  ordered,  which  produce  a  few  stools.  The  con- 
junctiva of  the  right  eye  then  suppurated,  for  which  a  blister  was  applied  at  the  nape  of 
the  neck.  The  patient  complained  of  great  pain  in  the  hypogastrium.  Manna  was  again 
ordered.  Nevertheless  the  suffering  increased,  and  she  had  no  sleep  the  next  night.  The 
next,  when  I  saw  her,  she  was  lying  on  the  back,  with  the  head  inclined  backwards,  the 
face  discolored,  the  lips  black,  voice  almost  gone,  respiration  very  difficult,  frequent  pulse, 
skin  cold.  From  the  dyspnoea,  we  suspected  a  latent  pneumonia,  and  then  we  endeavored 
to  re-establish  the  running  of  the  fistulse.  For  this  purpose  a  large  blister  was  applied,  but 
without  any  effect,  she  having  died  at  five  in  the  morning. 

Jlutops.  cadav. — twenty-four  hours  after  death. 

1.  Cranium. — The  membranes  were  healthy,  except  at  the  superior  and  middle  part  of 
the  right  hemisphere;  there  was  a  slight  infiltration  of  the  sub- arachnoid  cellular  tissue,  and 
the  pia  mater  adhered  at  this  point.  The  gray  substance  was  natural,  but  the  white  injected ; 
in  cutting  it,  the  blood  flowed  from  the  orifices  of  its  vessels ;  its  consistence  was  not  changed. 
The  gray  substance,  in  the  space  of  three  convolutions,  corresponding  to  the  spot  where  the 
membranes  were  altered,  was  of  a  red,  mixed  with  a  yellow  color;  it  had  lost  the  shining 
appearance  of  the  other  convolutions;  it  was  unequal,  and,  as  it  were,  tubercular,  and  seve- 
ral small  red  paints  were  to  be  seen  on  its  surface.  Its  consistence  was  not  every  where  the 


*  Op.  cit.,  Case  XVI.  p.  88. 


310  HUMAN   BRAIN. 

same :  the  superficial  layer  could  easily  be  removed  by  the  handle  of  the  scalpel,  and  seemed 
as  if  it  had  been  boiled ;  the  deep  layer  was  much  injected,  and  was  nearly  of  the  same 
consistence  as  the  neighboring  parts.  The  gray  substance  was  thinner  in  the  extent  of  the 
affection  than  elsewhere. 

2.  Abdomen. — There  were  evident  traces  of  chronic  peritonitis.     The  abdominal  organs 
presented  some  peculiarities  which  it  would  be  useless  to  relate  here. 

3.  Thorax. — The  pleura  pulmonalis  of  the  left  side  strongly  adhered  to  the  pleura  costalis. 
The  left  lung  was  slightly  congested  posteriorly,  and  easily  torn.     The  right  lung  was  per- 
fectly healthy.     The  heart  was  nearly  in  a  normal  state. 

The  two  cases  just  related  are  very  remarkable,  because  both  the  patients  show  no  other 
signs  of  cerebral  disorder  than  a  slight  defect  in  the  intellect.  It  is  known  that  latterly  MM. 
Foville  and  Pinel-Grandchamp  have  maintained  that  the  gray  substance  presides  over  the 
intellectual  phenomena,  and  the  white  over  the  movements.  If  their  assertion  is  correct, 
it  follows,  that  in  both  these  patients  there  ought  to  have  been  lesion  of  the  gray  substance 
only:  this  is  also  what  we  have  seen.  It  is  true  that  the  last  patient  had  general  convul- 
sions :  but  this  phenomenon  evidently  depended  on  the  inflammation  of  the  arachnoid,  which 
showed  itself  in  the  last  days,  and  to  which  she  fell  a  victim. 

Case  14. — Great  grief ;  torpor  of  the  left  arm  ;  a  stupid  and  imbecile  look  ;  alteration  of  in- 
tellect ;  loss  of  the  power  of  speech,-  death  24th  day.  Ramollissement  of  the  convexity  of  the  cere- 
brwm,  particularly  of  the  gray  substance ;  albunrinous  granulations,  with  an  ash  color  of  the  sur- 
rounding parts,  and  injection  of  the  meninges.* — Mary  Morlet,  23  years  of  age,  a  laboring-wo- 
man, strongly  built,  of  a  melancholic  character,  has  been  constantly  fretting  for  about  a  year, 
or  since  she  left  her  native  place.  She  is  taciturn,  and  for  some  time  has  not  spoken  to  the 
women  working  with  her ;  for  the  last  four  months  she  has  not  been  regular,  which  makes 
her  fear  that  she  is  in  the  family  way.  This  idea  augments  her  troubles.  Her  superior 
extremity  is  now  in  a  state  of  torpor,  and  she  is  taken  to  the  Hospital  Cochin,  the  31st  De- 
cember, 1821. 

The  1st  of  January,  1822,  she  is  very  much  depressed,  and  complains  of  pain  all  over  the 
body  and  of  torpor  of  the  right  arm,  symptoms  which  greatly  disturb  the  patient ;  she  ap- 
pears stupid;  her  ideas  seem  fixed;  her  answers  are  not  pertinent;  her  face  is  without 
expression;  the  pulse  small,  contracted,  as  if  convulsive;  the  breath  slightly  fretid ;  skin 
hot  and  dry,  and  there  is  pain  in  the  epigastrium.  (Twenty  keches  on  the  abdomen;  lemonade  ; 
low  diet) 

No  change  in  the  following  week.  She  appeared  indifferent  to  all  that  surrounded  her; 
she  seemed  to  be  consumed  by  a  series  of  dominating  ideas.  (Venesect,  at  the  arm;  blister  to 
the  nape  of  the  neck;  demulcent  drink  and  bouillon.') 

Jan.  9.  The  patient  answers  none  of  our  questions,  and  merely  says  Faut-il?  which  she 
constantly  repeats  in  a  sad  tone  of  voice ;  the  arm  is  paralyzed,  stiff,  and  oedematous ;  the 
features  are  contracted,  the  forehead  is  corrugated;  she  coughs,  and  her  respiration  difficult; 
face  red,  pulse  frequent  and  irregular;  the  pulse  consists  of  a  series  of  precipitated  oscilla- 
tions, separated  by  very  sensible  intermittences ;  face  terreous ;  nose  cold  and  pointed . 
(Sinapisms  to  the  feet,  which  scarcely  redden  the  skin) 

The  10th.  Same  state.     (Blister  to  the  nape  of  the  neck,  which  does  not  take.) 

The  12th.  Her  physiognomy  appears  animated ;  the  features  are  more  expanded ;  she 
seems  to  understand  what  is  said  to  her,  but  makes  no  answer,  and  only  says  Fautil? 

The  13th.  Urinary  and  alvine  excretions  involuntary;  sinking;  eye  fixed;  concentrated 
pulse,  soft,  slower. 

The  14th.  More  motion  of  eye;  expression  not  so  sad;  she  smiles. 

Same  state  till  the  17th.     (Arnaca;  bouillon.) 

The  18th.  Sadness  returned;  eyes  black  and  blue,  sunk;  same  state  of  the  intellectual 
functions. 

The  19th,  20th,  and  21st.  The  depression  increased,  vomiting.  (Another  blister  to  the  head, 
which  does  not  take) 

The  22d.  In  the  evening,  profound  coma;  little  pulse,  thread-like,  and  frequent;  respira- 
tion plaintive  and  suspirious;  eye  widely  open,  fixed;  foolish  look,  and  trismus. 

The  23d.  Eye  fixed  and  dull;  pupils  dilated,  immovable;  respiration  noisy,  rattling; 
plaintive  sighs;  convulsive  agitation  of  the  left  arm.  (  Venestet .  in  the  arm.)  Death  at  three 
in  the  afternoon. 

Autops.  cadav. — thirty-six  hours  after  death. 

Encephalon. — The  arachnoid  covering  the  dura  mater  is  healthy;  the  surface  of  the  brain 
red  and  much  injected,  especially  at  the  posterior  convolutions  of  the  right  hemisphere;  red- 
ness and  injection,  which  appear  to  be  owing  to  the  presence  of  the  pia  mater,  the  tissue  of 
which  is  much  gorged  with  blood.  Having  removed  this  vascular  network^ the  surface  of  the 


*  Op.  cit.,  Ca.se  XYU.  p,  93. 


INFLAMMATION    OF   THE   HEMISPHERICAL   GANGLION.          311 

cerebral  convolutions  is  covered  by  an  infinite  number  of  clots  of  blood  ;  concrete  albuminous 
granulations  are  spread  here  and  thereon  the  convexity  of  the  left  hemisphere,  and  extend  to 
that  part  of  the  right  hemisphere  which  corresponds  in  the  middle  to  the  great  cerebral  division. 
These  granulations  are  grouped,  and,  as  it  were,  agglomerated  in  three  principal  places,  which 
are  the  seat  of  the  mischief.  The  most  extended  of  these  groups  implicates  the  two  hemi- 
spheres of  the  brain,  but  the  left  much  more  than  the  right,  and  it  occupies  the  middle  and 
internal  convolutions  of  the  superior  surface  of  this  organ :  there  the  arachnoid  which  adheres 
to  the  brain  is  covered  by  granulations;  it  is  opaque  and  thick :  beneath  it  the  cerebral  sub- 
stance is  softened ;  its  consistence  is  pulpy,  of  a  gray  red  color,  much  resembling  the  ence- 
phaloid  tissue,  softened  and  combined  with  a  certain  quantity  of  blood.  This  softening  ex- 
tends about  four  or  five  lines  in  depth,  and  its  longitudinal  diameter  is  from  eight  to  ten  lines. 
The  other  smaller  places  present  the  same  characters;  the  albuminous  granulations  are  of 
the  size  of  a  grain  of  hemp-seed,  and  resemble  the  tubercles  often  found  on  the  external 
surface  of  the  intestines.  These  granulations  are  found  in  the  seats  of  the  disease,  so  that 
there  exist  at  the  same  time  softening  and  hardening  of  the  cerebral  substance.  There  is 
here  tuberculous  and  encephaloid-lookiug  matter,  evidently  produced  by  phlegmasia.  The 
gray  substance  surrounding  ttiese  parts  is  of  a  well-marked  ash-color.  The  lateral  ventricles 
only  contain  a  few  drops  of  sanguineous  serum;  the  cerebellum  and  spinal  marrow  are 
healthy ;  the  pia  mater  which  envelops  them  is  red  and  injected. 

Thoracic  Organs. — The  lungs  are  healthy;  the  pericardium  distended,  fluctuating;  it  ex- 
tends as  far  as  the  right  side  of  the  chest,  and  contains  from  six  to  eight  ounces  of  lemon- 
colored  serum.  The  heart,  swimming  in  this  fluid,  is  not  at  all  changed;  its  right  cavities, 
gorged  with  blood,  are  a  little  dilated. 

Abdominal  Organs. — The  stomach  and  small  intestines  are  in  a  normal  state ;  there  are  a 
few  ulcerations  in  the  large  intestines.  The  uterus  is  healthy.  The  tissue  of  the  tube  and 
ovaries  is  red  and  as  it  were  erectile :  the  fimbriated  extremity  of  the  tubes  adheres  to  the 
ovaries,  on  which  it  (if  I  may  use  the  term)  is  grafted. 

In  this  last  case  the  softening  had  proceeded  slowly ;  the  phlegmasia  had  certainly  been 
a  chronic  one,  whilst  in  the  preceding  cases  it  had  proceeded  in  a  very  rapid  manner,  and 
the  inflammation  in  general  had  been  of  an  acute  kind :  we  find  the  same  thing  in  the  fol- 
lowing case  related  by  M.  Avoyrie : 

Case  1 5. — Cephalalgia  ;  furious  delirium ;  convulsions  alternating  with  a  state  of  collapse : 
death. — Arachnitis,  with  softening  of  the  cortical  substance  of  the  cerebral  hemispheres* — A.  Ma- 
hon,  30  years  of  age,  of  a  sanguineous  biliary  temperament,  having  got  drunk,  fell  from  a 
first  story,  the  1st  of  January,  1846.  No  serious  mischief  arose  immediately  after  the  acci- 
dent; he  lost  a  little  blood  from  the  left  ear,  and  cephalalgia  supervened,  which  continued; 
but  on  the  fourth  day  it  greatly  augmented:  on  that  day,  towards  evening,  he  was  seized 
with  violent  delirium,  and  was  admitted  into  the  Hotel  Dieu,  where  he  was  tied  to  prevent 
his  getting  out  of  bed.  At  the  end  of  the  night  he  suddenly  fell  into  a  state  of  drowsiness. 
The  fifth  day  the  drowsiness  was  so  great  that  nothing  could  rouse  him ;  the  face,  a  little 
pale,  had  a  gloomy  appearance;  the  eyelids  were  shut;  in  separating  them  the  eyes  were 
directed  to  the  right  side ;  the  head  was  inclined  to  the  same  side,  and  if  this  position  was 
changed,  it  was  immediately  regained;  the  jaws  were  firmly  shut;  the  pulse  slow  but  full; 
the  patient  now  and  then  agitated  his  arms,  and  sighed  frequently.  Neither  the  cranium 
nor  the  other  parts  of  the  body  showed  any  trace  of  contusion.  (Infusion  of  Roman  chamo- 
mile  with  tamarinds ;  blister  to  the  nape  of  the  neck ;  sinapisms  to  the  knees.')  Drowsiness  dimi- 
nished during  the  day,  without  the  return  of  the  intellectual  faculties ;  in  the  evening  furious 
delirium  appeared  at  intervals.  The  6th,  in  the  morning,  delirium  had  ceased;  drowsiness 
not  so  great.  He  now  and  then  opened  his  eyes,  but  soon  shut  them  again :  he  moved  his 
limbs,  but  he  constantly  sighed ;  the  eyes  were  still  directed  to  the  right,  and  the  jaws  shut, 
the  face  a  little  discolored.  ( Three  leeches  on  each  side  of  the  neck,  and  cupping-glasses  on  the 
tvounds.')  The  patient  was  sensible  of  the  application  of  the  cupping-glasses,  and  had  no  de- 
lirium in  the  night.  The  seventh  day,  in  the  morning,  very  nearly  the  same  state;  some- 
times the  eyes  were  open  for  a  length  of  time,  but  without  sight.  (Hydromel;  tamarinds; 
ice  on  the  head ;  sinapised  fomentations.')  In  the  evening  he  began  to  sink,  and  continued  so 
till  the  morning  at  six,  when  he  died.  , 

Autops.  cadav. — The  cerebrum  was  disorganized  in  many  places  on  its  superior  surface, 
and  there  were  collections  of  blood  between  the  pia  mater  and  the  arachnoid.  This  disor- 
ganization, which  was  only  superficial,  was  rather  deep  in  the  posterior  part  of  the  posterior 
lobe  of  the  left  side;  all  the  encephalic  mass  was  red,  yellow  at  some  parts,  and  very  soft. 
The  lateral  ventricles,  extraordinarily  dilated,  contained  a  large  quantity  of  serum.  All  the 
other  parts  of  the  body  were  healthy. 

The  symptoms  in  this  case  did  not  indicate  the  existence  of  an  acute  inflammation  of  the 

*..i  -     '    '    -  •'      •  ' 

*  Op.  cat.,  Case  XVIII.  p.  98. 


312  HUMAN   BRAIN. 

arachnoid ;  but  you  see  that  the  phlegmasia  is  not  confined  to  the  meninges,  since  the  corti- 
cal substance  of  the  superior  convolutions  of  tbjC  brain  was  disorganized  in  many  places,  with 
very  considerable  injection.  The  intellectual  disorder  must  be  attributed  to  the  irritation  of 
the  gray  substance  which  accompanies  inflammation  of  the  arachnoid.  You  are  aware  that 
MM.  Parent  and  Martinet  have  shown,  by  a  great  number  of  facts,  that  delirium  corre- 
sponded to  inflammation  of  that  portion  of  the  arachnoid  which  covers  the  convexity  of  the 
brain,  which  tends  to  confirm  the  opinion  of  those  who  think  that  the  intellectual  faculties 
reside  in  the  gray  substance  of  the  convolutions. 

Case  16. — Contusion  of  the  cranium;  no  remarkable  cerebral  symptoms  the  first  days,  then 
furious  delirium  ;  coma  ;  death  the  20th  day. — Abscess  in  the  gray  substance  of  the  convexity  of  the 
cerebrum;  inflammation  and  disorganization  of  the  arachnoid* — Antoine  Broussart,  65  years  of 
age,  having  experienced  great  losses  in  commerce,  and  being  reduced  to  great  misery,  gave 
himself,  on  the  6th  of  January,  in  the  morning,  many  blows  on  the  head  with  a  hammer; 
but  not  succeeding  in  killing  himself,  he  takes  a  bad  pair  of  scissors,  seizes  the  right  testicle 
with  the  left  hand,  and  removes  it  with  the  scissors.  This  furious  fellow  is  mastered,  and 
is  taken  to  the  hospital  La  Charite.  On  the  road  he  tried,  but  in  vain,  to  strangle  himself. 
On  his  arrival  the  surgeon  who  was  present  observed  about  the  line  of  union  of  the  parietal 
bones  with  the  frontal,  a  considerable  tumor,  which  he  opened  by  a  crucial  incision,  to  allow 
the  extravasated  blood  to  escape,  and  to  ascertain  whether  there  was  any  fracture.  The 
next  day,  the  7th,  M.  Roux  examined  the  wound,  and  stated  that  there  was  no  fracture,  and 
had  it  dressed  in  the  ordinary  way,  as  well  as  that  of  the  scrotum.  (Low  diet,  petit  lait  erne- 
tise.)  The  8th,  no  accident  has  occurred.  The  following  days  the  patient  was  getting  bet- 
ter, when  the  wound  of  the  head,  which  till  then  had  secreted  a  large  quantity  of  pus,  began 
to  get  dry.  The  20th  he  fell  into  a  state  of  coma;  his  pulse  became  hard  and  quick,  his 
skin  exceedingly  hot;  an  ichorous  matter  flowed  from  the  nostrils.  To  this,  furious  delirium 
supervenes;  the  patient  jumps  out  of  bed,  threatens  his  neighbors,  wishes  to  fight  them, 
when  he  is  seized  by  two  nurses,  who  replace  him  in  bed  and  tie  him  to  it.  He  expires  in 
a  quarter  of  an  hour. 

Jlutaps.  cadav. — The  dura  mater,  which  is  thickened,  is  covered  by  a  yellow  false  mem- 
brane, and  on  its  internal  surface  are  a  few  black  tubercles ;  the  pia  mater  is  equally  thick- 
ened ;  the  arachnoid  is  nearly  altogether  disorganized,  especially  between  the  convolutions 
of  the  cerebrum,  which  are  bathed  with  pus ;  the  superficial  layers  of  this  part  are  softened, 
and  in  a  state  of  suppuration :  there  is  nothing  else  worthy  of  remark.f 

This  case  confirms  what  we  have  already  said,  viz.,  that  a  circumscribed  lesion  of  the 
gray  substance  has  no  direct  influence  on  the  movements  of  tho  extremities.  Effectively, 
the  patient  rises  in  a  furious  state  the  day  of  his  death,  threatens  to  maltreat  his  neighbors, 
and  cannot  be  kept  quiet  until  he  is  tied.  On  opening  the  cranium,  an  abscess  was  found, 
terminating  in  the  gray  substance  of  the  brain.  As  to  the  delirium,  the  agitation,  and  the 
fever,  they  are  accounted  for  by  the  phlegmasia  of  the  arachnoid. 

Case  17. — Slow  answers ;  alteration  of  the  intellectual  faculties  ;  a  species  of  idiotism,  without 
paralysis  or  convulsions  of  the  extremities ;  death  the  31th  day. — Two  large  abscesses,  occupying 
the  middle  of  the  cerebral  hemispheres.^ — A  soldier,  twenty  six  years  of  age,  brown,  robust, 
and  sanguineous,  was  in  the  military  hospitals  of  Pan  in  November,  1813.  At  his  arrival 
he  said  he  had  been  unwell  for  fifteen  days;  but,  his  ideas  being  confused,  this  statement 
could  not  be  relied  upon,  and  he  could  give  no  exact  account  of  the  phenomena  of  the  inva- 
sion. He  was  tranquil,  scarcely  answered,  the  eyes  wide  open,  with  a  stupid  look,  and  he 
complained  of  nothing.  He  could  get  up  to  ease  himself.  His  face  was  much  colored, 
especially  the  cheeks;  tongue  red,  abdomen  painful  on  pressure,  the  skin  extremely  hot  to 
the  touch,  pulse  rather  slow,  pretty  full  and  developed,  appetite  fair. 

After  ten  or  twelve  days  he  appeared  to  be  convalescent;  but  the  stupidity  and  quietude 
remained.  He  seldom  answered,  and  with  much  brevity ;  he  frequently  refused  to  get  up, 
but  frequently  sat  up  in  bed,  and  looked  stupidly  at  that  which  was  going  on  about  him. 
He  only  spoke  when  he  wanted  something  to  eat,  or  to  satisfy  some  other  want.  At  the 
end  of  five  or  six  days  the  heat  and  frequency  of  the  pulse  re-appeared;  diarrhoea  then 
came  on,  and  the  febrile  action  subsided.  The  torpor  increased,  the  wants  were  no  longer 
known,  and  he  died,  without  convulsions,  the  twenty-second  day  of  his  arrival,  and  the 
thirty-seventh  of  the  invasion,  according  to  his  account. 

dutops.  cadav. — Head. — Two  large  places  filled  with  greenish  pus,  sticky,  and  inodorous, 
each  occupying  the  middle  of  one  cerebral  hemisphere,  not  communicating  with  the  lateral 
ventricles,  but  surrounded  by  a  white  cyst,  formed  of  a  sort  of  concrete  pus  easily  broken 
up ;  with  this  a  considerable  injection  of  all  the  encephalori. 

*  Op.  cit.,  CaseXXTI.p.  116. 

t  This  case  was  reported  by  Dr.  Hennelle,  then  house  student  at  the  hospital  of  La 
Charit&  J  Op.  cit.,  Case  XXVI.  p.  128. 


INFLAMMATION    OF    THE    HEMISPHERICAL    GANGLION.  313 

u  If  we  take  into  consideration  these  facts,"  says  M.  Bouillaud,  "  which  might  be  multiplied 
ad  infinitum ;  if  you  remark,  besides,  that  tho.se  physicians,  who  have  recently  employed 
themselves  in  the  study  of  mental  alienation,  have  remarked  that  it  was  always  accom- 
panied with  a  disorganization  more  or  less  deep  of  the  cortical  substance  of  the  superior 
convolutions  of  the  brain  ;  if  you  reflect,  lastly,  that,  as  has  been  truly  observed  by  MM. 
Parent  and  Martinet,  delirium  is  connected  with  inflammation  of  that  portion  of  the  arach- 
noid which  covers  the  convexity  of  the  brain — you  will  certainly  be  very  much  disposed  to 
agree  with  the  opinion  of  MM.  Fovel  and  Pinel-Grandchamp,  which  places  the  seat  of  in- 
telligence in  the  cortical  substance  of  the  superior  part  of  the  brain." 

I  quite  agree  with  Dr.  Abercrombie  that  it  is  impossible  to  separate 
inflammation  of  the  arachnoid  and  pia  mater,  either  in  diagnosis  or  in 
treatment;  but  I  may  again  add  also,  that  it  is  impossible  to  separate 
inflammation  of  these  membranes  from  that  of  the  hemispherical  ganglion 
or  cortical  substance  of  the  brain. 

Dr.  Abercrombie  employed  the  term  meningitis  to  express  the  disease, 
meaning  thereby  inflammation  of  the  arachnoid,  or  pia  mater,  or  both, 
as  distinct  from  inflammation  of  the  dura  mater. 

Andral*  says  that  most  of  the  lesions  of  which  medical  men  place  the 
seat  in  the  arachnoid  are  really  diseases  of  the  pia  mater.  In  almost  all 
the  cases,  for  instance,  where  the  convexity  of  the  cerebral  hemispheres 
was  covered  with  a  layer  of  serum  or  pus,  this  layer  had  its  seat  beneath 
the  arachnoid  ;  on  passing  the  back  of  the  scalpel  over  the  latter  mem- 
brane, the  morbid  product  is  displaced,  but  not  removed.  However, 
whilst  we  admit  that  in  the  diseases  designated  by  the  name  of  arachnitis, 
or  more  properly  meningitis,  anatomy  discovers  lesions  in  the  pia  mater 
much  more  frequently  than  in  the  arachnoid,  still  we  should  not  assert, 
as  some  writers  do,  that  the  arachnoid  always  remains  unaffected. 

Dr.  Abercrombie  considered  the  phrenitis  of  systematic  writers  in- 
flammation of  the  membranes  of  the  brain.  "  It  is  characterized,"  says 
this  admirable  observer,  "  by  fever,  watchfulness,  acute  headache,  im- 
patience of  light,  suffusion  of  the  eyes,  and  maniacal  delirium.  This 
affection,  however,  is  seldom  met  with  as  an  idiopathic  disease,  except 
in  a  few  cases  in  which  it  is  brought  on  by  the  abuse  of  strong  liquors, 
and  in  warm  climates  by  exposure  to  the  intense  heat  of  the  sun.  As  a 
symptomatic  affection,  it  is  met  with  occasionally  in  fever,  and  in  ma- 
nia ;  and  a  condition  nearly  allied  to  it  sometimes  occurs  after  injuries 
of  the  head.  Circumstances  will  be  afterwards  mentioned,  which  ren- 
der it  probable  that  in  this  form  of  the  disease  the  inflammation  is  prima- 
rily seated  in  the  membranes  of  the  brain.  When  fatal,  it  is  generally 
by  a  rapid  sinking  of  the  vital  powers  supervening  upon  the  high  excite- 
ment, without  producing  much  disorganization  of  the  parts  which  appear 
to  have  been  the  seat  of  the  disease  ;  for  the  cases  which  are  referable 
to  this  class,  when  they  terminate  fatally,  are  generally  rapid  in  their 
progress,  and  the  appearances  on  dissection  are  often  unsatisfactory. 
There  is  an  affection  of  frequent  occurrence,  which,  perhaps,  maybe  re- 
ferred to  this  head.  It  is  characterized  by  a  peculiar  aberration  of  mind 
without  any  complaint  of  pain.  There  is  a  remarkable  restlessness, 
quickness,  and  impatience  of  manner,  obstinate  watchfulness,  and  inces- 
sant rapid  talking,  the  patient  rambling  from  one  subject  to  another  with 
little  connection,  but  often  without  any  actual  hallucination  ;  he  knows 

*  Clinique  M&Ucale  Trans.,  by  Spillan,  p.  42. 

».'   *" 


314  HUMAN   BRAIN. 

those  about  him,  and  generally  answers  distinctly  questions  that  are  put 
to  him.  There  is  a  rapid  pulse,  but  without  the  other  symptoms  of 
fever,  and  the  disease  is  apt  to  be  mistaken  by  a  superficial  observer  for 
mania,  and  consequently  to  be  considered  as  not  attended  with  danger. 
But  it  is  an  affection  of  very  great  danger,  and  often  rapidly  fatal.  The 
nature  of  it  is  obscure,  and  the  appearance  of  it  on  dissection  rather 
unsatisfactory ;  it  consists  chiefly  of  a  highly  vascular  state  of  the  pia 
mater,  without  any  actual  result  of  inflammation." 

We  cannot,  I  think,  ascribe  the  mental  disturbance,  excitement,  ex- 
cessive pain,  intolerance  of  light,  delirium,  and  insanity,  which  have 
been  observed  as  the  diagnostic  marks  of  inflammation  of  the  arachnoid 
and  pia  mater,  to  a  simple  lesion  of  either  a  serous  or  vascular  mem- 
brane ;  we  are  compelled  to  refer  them  all  to  the  injury  which  that  por- 
tion of  the  brain  that  is  in  contact  with  these  membranes  has  received 
from  inflammatory  action. 

Bayle,*  in  his  admirable  work  on  diseases  of  the  brain,  strongly  sup- 
ports the  opinion  that  inflammation  of  the  arachnoid  is  characterized  by 
mental  alienation.  1st,  he  states  distinctly  and  broadly  that  "  most 
mental  alienations  are  a  symptom  of  chronic  primary  phlegmasia  of  the 
membranes  of  the  brain."  He  also  draws  an  important  distinction  be- 
tween inflammation  of  the  arachnoidea  reflexa,  or  that  lining  the  dura 
mater,  and  the  arachnoidea  investiens,  or  that  in  contact  with  the  pia 
mater  and  covering  the  brain.  The  first  he  calls  chronic  or  latent 
arachnitis,  the  second  chronic  meningitis,  because  it  affects  both  arach- 
noid and  pia  mater. 

Bayle  considers  that  a  certain  number  of  monomaniacs  and  melancho- 
lic patients  have  primarily  derived  the  disease  from  a  deep  and  durable 
lesion  of  the  moral  affections,  and  to  a  ruling  error  which  controls  more 
or  less  the  will  of  the  patient,  and  becomes  the  basis  of  an  excessive  de- 
lirium. But  he  says,  UI  am  far  from  saying  that  matter  has  no  influ- 
ence in  the  development  of  these  species  of  derangement.  I  do  not 
speak  of  their  origin,  which  is  purely  mental ;  but  we  shall  see  that  in 
certain  hereditary  and  constitutional  predispositions,  these  mental  de- 
rangements produce  upon  the  brain  and  its  appendages  certain  effects, 
which  in  their  turn  become  a  cause  of  certain  symptoms,  and  that  thus 
there  is  a  re-action  of  the  moral  on  the  physical  and  of  the  physical  on 
the  moral." 

This  accords  with  the  affection  which  I  have  described  as  inflamma- 
tion of  the  hemispherical  ganglion  from  within  as  distinguished  from 
meningitis. 

Bayle  considered  that  some  very  rare  alienations  depend  on  a  specific 
or  sympathetic  irritation  of  the  brain.  If  Bayle  means  that  any  mental 
alienation  exist  without  a  temporary  or  permanent  morbid  concretion  of 
the  capillary  system  of  the  brain,  I  do  not  agree  with  him. 

The  more  I  have  seen  of  the  post-mortem  appearances  which  are  left 
in  cases  of  mental  derangement,  the  more  I  am  convinced  that  each 
form  has  its  respective  lesion,  though  I  am  far  from  pretending  that  they 
have  been  all  discovered.  The  signs  of  meningitis  during  life  are  varied 
and  obscure. 

*  Trait^  des  Maladies  du  Cerveau  et  de  ses  Membranes,  par  A.  L.  Bayle,  1826. 


INFLAMMATION   OF   THE   HEMISPHERICAL    GANGLION.  315 

Parent  Duchalelet  and  Martinet*  divide  the  stages  of  arachnitis  into 
three.  The  first  is  generally  manifested  by  an  exaltation  of  sensibility, 
from  whence  arises  cephalalgia,  one  of  its  most  constant  characters. 
When  it  is  seated  at  the  base  of  the  brain,  there  is  frequently  a  tendency 
to  drowsiness,  which  may  give  place  to  nausea  and  vomiting  ;  generally 
there  is  some  fever.  The  stage  of  excitement  is  very  variable  in  its 
form,  according  to  the  age  of  the  patient,  the  part  that  is  inflamed,  the 
constitution  and  the  degree  of  sensibility  of  the  subject  of  it.  Its  dura- 
tion varies  from  some  hours  to  one,  two,  three,  or  four  days  ;  sometimes 
it  is  prolonged  up  to  two  weeks,  but  this  is  rare,  and  the  symptoms  are 
then  very  vague  and  uncertain.  The  patients  are  in  a  mixed  state  of 
health  and  disease.  When  this  occurs,  it  is  generally  in  weak  cachectic 
persons,  or  in  infants. 

The  second  period  is  a  true  period  of  reaction,  accompanied  with 
disturbance  of  the  muscular  system,  corresponding  to  that  of  the  brain, 
convulsions,  delirium,  agitation,  contractions,  oscillation,  and  the  com- 
mencement of  dilatation  of  the  pupils.  In  this  period  the  headache  is 
less  constant  than  in  the  first.  This  period  is  usually  the  longest  in  its 
duration,  varying  from  two,  three,  or  four  days  up  to  one  or  two  weeks. 
It  presents  some  differences  according  to  its  seat.  Inflammation  of  the 
arachnoid  at  the  base  and  in  the  ventricles  is  almost  essentially  combined 
with  convulsions,  agitation,  affection  of  the  globe  of  the  eye,  while 
that  on  the  convexity  or  the  upper  part  of  the  hemispherical  ganglion  is 
characterized  by  delirium. 

The  third  period  is  the  shortest  in  its  duration,  varying  from  some 
hours  to  three  or  four  days,  rarely  prolonged  beyond  this.  It  is  the  period 
of  collapse,  of  the  abolition  of  the  senses,  a  loss  of  movement,  local  and 
general  paralysis,  coma.  At  this  period  it  is  difficult  to  distinguish  posi- 
tively the  existence  of  simple  arachnitis.  My  own  observation  corre- 
sponds with  the  above  authors  in  the  general  characters  of  these  symptoms, 
especially  in  the  distinction  between  the  symptoms  which  attend  lesions 
at  the  base  of  the  brain  and  in  the  ventricles,  from  that  which  accompany 
inflammation  of  the  upper  part  of  the  ganglion.  But  I  do  not  think  they 
have  laid  sufficient  stress  on  the  mental  excitement. 

Dr.  Neisserf  remarks  very  justly  that  the  symptoms  of  effusion  are 
sometimes  marked  by  the  excitement  of  the  brain  resisting  the  oppres- 
sive effect  of  the  extravasated  fluid,  so  that  there  is  a  sort  of  balance 
between  the  symptoms. 

AndralJ  bears  his  testimony  to  the  constancy  of  lesions  of  intelligence 
accompanying  meningitis  ;  such  lesion  presenting  itself  either  under  the 
form  of  delirium  or  coma.  The  delirium  may  present  the  greatest  varie- 
ties with  respect  to  its  nature  ;  in  some  it  is  very  violent,  accompanied 
with  loud  cries,  and  a  great  development  of  muscular  strength.  In  others, 
on  the  contrary,  it  is  of  a  silent  description,  and  the  patients  appear  very 

*  Recberches  sur  I'lnflammation  de  l'araohd.  cerebral  et  spinal,  ouvrage  fait  conjointement. 
Paris,  1821. 

f  Die  Acute  Entziindung  der  Sercisen  Haute  des  Gebirns  und  Rtickenmarks  nacb  eigenen 
Beobachtungen  am  Krankenbett  Gesclirieben.  Von  Pr.  Joseph  Neisser,  Prakt.  Arzt.  zu  Ber- 
lin, 1845. 

j  P.  56,  op.  cit. 


316  HUMAN   BRAIN. 

^ 

much  prostrated  in  strength.  Sometimes  one  single  idea  engages  the 
mind  of  the  patient ;  sometimes  ideas  of  the  most  heterogeneous  descrip- 
tion occupy  his  thoughts.  In  some  this  disturbance  of  intellect  attains 
its  highest  degree  from  the  very  commencement;  in  others  it  comes  on 
gradually  and  insensibly.  On  reviewing  in  each  case  the  numerous 
varieties  of  form  which  the  delirium  presented,  we  might  arrive  at  this 
important  conclusion, — that  no  single  one  of  these  various  forms  charac- 
terizes meningitis,  that  there  is  not  one  of  them  which  may  not  be  found 
in  the  different  cerebral  irritations  which  are  purely  sympathetic,  and 
unaccompanied  with  any  structural  alteration  of  the  membranes  appre- 
ciable on  the  dead  body. 

When  once  the  delirium  has  developed  itself,  it  may  not  cease,  pre- 
senting merely  alternations  of  exacerbation  and  remission ;  it  may  also 
be  only  transitory.  There  are  some  patients  in  whom  this  disturbance 
of  the  intellectual  faculties  is  but  of  very  short  duration;  then  at  the  end 
of  a  period  more  or  less  long,  it  returns;  the  intermissions  become  more 
and  more  short,  and  at  last  the  disturbance  becomes  continued.  In  some 
the  delirium  commences  only  at  night,  and  the  clearness  of  the  intel- 
lect during  the  day  seems,  at  first,  to  exclude  the  idea  of  meningitis 
altogether.  In  some,  a  delirium  of  several  days'  duration  suddenly 
disappears  a  little  before  death,  when  the  other  symptoms  become 
more  aggravated.  Wherefore,  when  it  is  attempted  to  distinguish  the 
delirium  produced  by  meningitis  from  the  delirium  produced  by  sympa- 
thetic irritation  of  the  brain,  it  is  wrong  to  lay  it  down  that  the  latter 
only  can  be  intermittent,  for  numerous  cases  prove,  beyond  all  doubt, 
that  delirium  arising  from  meningitis  may  be  accompanied  with  perfectly 
lucid  intervals.  The  period  of  the  disease  at  which  the  delirium  appears 
is  far  from  being  the  same  in  every  case.  Very  rarely  this  phenomenon 
marks  the  outset  of  the  malady  ;  so  that,  in  the  midst  of  health,  when 
delirium  does  suddenly  come  on,  it  is  not  at  all  probable  that  it  is  depend- 
ent on  meningitis.  In  the  great  majority  of  cases,  pain  of  head  precedes 
it;  and  oftentimes  six,  eight,  twelve,  and  even  fifteen  and  twenty  days 
pass  on  between  the  period  at  which  the  pain  of  head  presents  itself 
and  that  at  which  the  intelligence  commences  to  be  disturbed. 

Andral  considers  that  the  diversity  of  the  lesions  of  intelligence  in 
meningitis  can  only  be  accounted  for  by  referring  to  the  differing  sus- 
ceptibility of  the  brain  to  impressions. 

My  reason  for  dwelling  so  fully  on  these  symptoms  of  mental  excite- 
ment as  indicative  of  inflammation  of  the  hemispherical  ganglion,  is  the 
belief  that  the  condition  of  the  intellectual  faculties  is  not  sufficiently 
attended  to  as  part  of  our  chain  of  evidence  when  we  attempt  to  diag- 
nose affections  of  the  brain. 

We  may  next  consider  the  various  causes  which  induce  meningitis 
or  inflammation  of  the  hemispherical  ganglion,  (and  in  using  the  term 
meningitis  I  do  so  for  its  brevity,)  and  the  symptoms  and  circumstances 
which  are  peculiar  to  these  varieties. 

Concussion  of  the  Brain. — In  both  a  practical  and  a  physiological 
point  of  view  all  injuries  of  the  skull,  as  productions  of  meningitis,  are 
especially  interesting;  almost  every  case  presents  some  new  and  peculiar 
feature  worthy  of  attention.  For  beautifully  as  nature  has  protected 


CONCUSSION   OF   THE   BRAIN.  317 

the  brain,  the  bony  case  which  has  been  contrived  for  this  purpose 
cannot  be  seriously  injured  without  some  disturbance  of  the  organs  con- 
tained within  it.  And  we  find  in  practice  that  all  injuries  of  the  skull 
occasion  more  or  less  derangement  of  the  intellectual  faculties. 

After  what  has  been  stated  regarding  the  connection  between  the  in- 
tellectual faculties  and  the  cortical  substance  of  the  upper  portion  of 
the  brain,  we  shall  be  prepared  to  observe  the  effect  produced  by  any 
serious  injury  to  the  textures  which  are  placed  in  such  close  contact  to 
this  organ. 

The  most  frequent  consequence  of  a  severe  blow  on  the  head  is  con- 
cussion of  the  brain.  Inasmuch  as  this  injury  frequently  leads  to  in- 
flammation of  this  organ,  it  will  be  well  now  to  consider  its  symptoms. 

Simple  concussion  or  shaking  of  the  brain  obliterates,  for  a  longer  or 
shorter  period,  according  to  the  degree  of  violence,  the  mental  pheno- 
mena which  are  exhibited  during  a  state  of  health.  The  patient  who, 
a  moment  before,  was  in  complete  possession  of  all  his  mental  faculties, 
receives  a  violent  blow  on  the  head,  and  in  an  instant  loses  his  con- 
sciousness, and  lies  dead  to  the  world  around  him.  This  result  we  sup- 
pose to  depend  on  the  particles  of  neurine,  of  which  the  brain  consists, 
being  put  into  a  state  of  vibration,  an  effect  which  interrupts  for  a  time 
the  natural  functions  of  the  organ. 

The  state  of  insensibility  sometimes  continues  only  for  a  few  minutes  ; 
in  other  cases  it  will  last  for  some  days,  the  patient  remaining  in  a  kind 
of  sleep,  insensible  to  ordinary  stimuli ;  the  eyes,  for  instance,  may  be 
opened  in  a  moderate  light,  and  he  will  not  apparently  be  aware  of  the 
presence  of  any  one;  but  if  a  strong  pencil  of  rays  be  thrown  upon  the 
iris  it  will  contract,  to  prevent  too  many  impinging  upon  the  retina,  and 
he  will  perhaps  turn  his  head  away  from  the  light.  A  conversation 
may  be  kept  up  by  his  bedside  without  disturbing  him ;  but  if  he  is 
called  loudly  by  his  name  he  gives  evidence  that  he  is  aware  of  the  cir- 
cumstance. As  recovery  gradually  takes  place,  the  patient  will  answer 
questions,  but  incoherently,  evidently  neither  understanding  their  im- 
port, nor  able  sufficiently  to  collect  his  thoughts  to  give  a  particular 
answer.  If  the  case  proves  favorable,  these  symptoms  disappear  by 
degrees,  the  patient  recovers,  and  no  traces  of  the  accident  remain. 
If,  however,  inflammation  supervene,  another  train  of  symptoms  makes 
its  appearance,  and  then  the  consequences  are  generally  fatal. 

No  one  who  has  once  observed  a  case  of  concussion  can  doubt  that 
the  intellectual  faculties  are  dependent  in  some  way  or  other  on  the 
brain  ;  but  at  the  same  time  it  is  clear  that,  in  a  physiological  point  of 
view,  this  is  the  whole  amount  of  evidence  furnished. 

It  is  extremely  important  in  all  cases  of  concussion  to  be  very  early 
alive  to  the  symptoms  which  indicate  the  commencement  of  meningitis. 
Of  all  effects  of  inflammation  on  the  human  frame  this  is  most  to  be 
dreaded.  We  cannot  be  too  much  on  our  guard  to  prevent  its  intrusion, 
or  too  careful  in  our  endeavors  to  distinguish  the  symptoms  which  indi- 
cate its  approach.  When  once  set  up  it  is  difficult  to  arrest,  and  when 
arrested  it  too  often  leaves  behind  it  consequences  which  are  felt  for  the 
remainder  of  life.  In  cases  of  injury  to  the  skull,  the  surgeon  so  much 


318  HUMAN    BRAIN. 

more  frequently  observes  the  effect  of  injury  to  the  brain  as  a  whole, 
than  merely  to  the  membranes  primarily  and  the  hemispherical  ganglion 
secondarily,  that  he  is  more  in  danger  of  overlooking  such  symptoms 
than  the  physician,  whose  attention  has  been  directed  to  this  disease  in 
its  idiopathic  form. 

When  inflammation  follows  concussion  of  the  brain,  it  is  more  usually 
inflammation  of  the  substance  and  the  lining  membrane  of  the  ventricles 
than  of  the  cortical  substance,  and  the  whole  train  of  symptoms  are  de- 
cided and  unequivocal  from  the  first ;  but  sometimes  the  effect  of  the 
concussion  passes  over  quickly,  and  the  patient  is  considered  out  of 
danger;  but  after  a  few  days  meningitis  supervenes  in  such  an  insidious 
manner,  that  it  is  overlooked  by  the  friends,  the  services  of  the  medical 
man  not  being,  as  they  suppose,  any  longer  required. 

I  believe  that  the  origin  of  many  cases  of  insanity  might  thus  be  traced 
which  might  have  been  prevented  if  the  first  symptoms  had  received  the 
attention  which  they  deserved. 

The  following  case  is  peculiarly  interesting  and  instructive  in  this 
point  of  view  : — 

Case  18. — James  Coker,  a  lad,  set.  14,  was  admitted  into  St.  Thomas's  Hospital,  May  9th, 
1846,  under  Mr.  Solly,  with  general  symptoms  of  concussion.  About  five  o'clock  in  the 
afternoon,  while  working  as  a  bricklayer's  laborer,  on  some  scaffolding  at  Woolwich,  he 
slipped,  and  fell  from  a  height  of  seventy  feet.  He  fell  across  a  piece  of  timber,  first  strik- 
ing the  lower  portion  of  the  abdomen  and  afterwards  his  head.  Mr.  Denne,  surgeon,  of 
Woolwich,  who  saw  him  a  few  minutes  after  the  occurrence  of  the  accident,  states,  that  he 
was  insensible,  pale,  cold,  and  almost  pulseless.  Warmth  was  applied  to  the  body,  a  slight 
stimulus  given,  and  when  reaction  had  sufficiently  taken  place,  he  was  sent  up  to  the 
hospital. 

On  admission  he  was  partially  insensible,  answered  when  spoken  to,  but  in  a  snappish 
way,  barely  answering  the  question  put  to  him;  pulse  somewhat  accelerated,  and  fuller 
than  natural;  pupils  dilated,  but  sensible  to  light;  skin  moist;  there  was  a  considerable 
swelling  on  the  left  groin,  and  tenderness  in  that  region.  Ordered,  by  the  house  surgeon, 
cal.  gr.  iij.  stat.  Hirud.  xij.  inguini  sinistro. 

May  10th,  9£  A.M. — Has  passed  a  restless  night,  but  is  more  sensible;  pulse  100,  pupils 
dilated,  countenance  pinched,  legs  drawn  up  in  bed,  crying  out  as  though  in  pain,  swelling 
in  the  groin  much  diminished.  Ordered  Hyd.  c.  creta  gr.  iij.  stat.  Head  to  be  shaved, 
Hirudines  iij.  sing,  temporibus;  a  patient  was  required  to  sit  by  his  side  to  keep  him  in  bed. 

May  10th,  9£  P.M. — When  Mr.  Solly  paid  his  visit  to-night,  he  found  him  in  the  following 
state: — His  countenance  pinched  and  anxious,  refusing  to  answer  any  questions,  making  use 
of  bad  and  violent  language,  and  very  noisy,  disturbing  the  whole  ward.  Pupils  dilated, 
contracting  sluggishly  to  the  light  of  a  candle,  right  rather  more  dilated  than  the  left.  He 
could  not  detect  any  local  injury  of  the  head,  and  the  patient  said  he  had  no  pain  there. 
There  was  some  tenderness  over  the  abdomen  ;  he  moved  his  left  leg  about  a  good  deal. 

His  extreme  irritability  and  restlessness,  and  his  semi-conscious  state,  led  Mr.  Solly  to  think 
that  some  inflammatory  action  was  commencing  in  the  hemispherical  ganglia.  Ordered, 
calomel  gr.  i.  quaque  hora,  donee  alvus  soluta  sit.  postea  duabus  horis.  Hirud.  xx.  capiti 
applicand. 

May  llth,  8£  A.M. — Not  much  change  has  taken  place;  he  has  been  very  restless  during 
the  night ;  his  bowels  have  not  been  relieved.  Still  continues  violent,  obstinate,  abusive,  and 
uses  most  vile  language. 

The  calomel  to  be  continued,  and  thirty  leeches  to  be  applied  to  the  head. 

l£  P.M. — His  bowels  have  been  freely  opened,  and  a  large  quantity  of  solid  feculent 
matter  voided. 

g  p.M. — Is  a  little  better,  more  conscious,  and  quieter,  bowels  purged,  mercurial  stools, 
pulse  jerking  144,  right  pupil  rather  more  dilated  than  the  left.  Kept.  Hirud.  xxx. 

Hyd.  c.  creta  gr.  ij.  Ext.  Aconiti  gr.  i.  Pulv.  Doveri  gr.  ij.  4ta  quaque  horl 

May  12th. — Has  passed  a  better  night;  quieter,  and  not  so  violent,  irritable  or  abusive; 
in  answer  to  a  question,  says  he  is  nicely,  better,  that  he  has  no  pain  in  the  head  ;  appears 
to  suffer  pain  in  the  abdomen,  but  does  not  say  so.  Emp.  Lyttae  abdomini  Ung.  Hydrarg. 
Fort,  for  dressing. 


CONCUSSION    OF    THE    BRAIN.  319 

1  P.M. — Sleeping;  head  rather  hot;  hands  cool  ;  cries  out  occasionally  without  any  appa- 
rent reason  ;  when  asked  why — does  not  know.  If  any  pain — answers  no.  Cold  lotion 
to  be  applied  to  the  head. 

10  P.M. — Much  better,  quieter,  and  more  sensible. 

May  13th,  8  A.M. — Sleeping  quietly,  rested  well  during  the  night,  pulse  116,  soft;  when 
he  awoke  he  said,  Oh,  give  me  somebody  to  take  care  of  me  !  When  asked  why — because 
I  feel  so  queer ;  if  he  had  any  pain  in  the  head  or  abdomen — said  he  did  not  know.  He 
recognized  Mr.  Solly,  but  soon  dozed  off  again. 

14th. — Sleeping;  when  he  awoke,  said  he  was  quite  well;  rambling;  head  very  hot; 
tongue  furred;  pulse  124.  Hirud.  xx.  capiti.  Discontinue  the  Dover's  powder  and  increase 
the  Hyd.  c.  creta  to  gr.  iij. 

Vesp. — Much  the  same,  pulse  120. 

15th. — Pale;  has  been  excessively  irritable  during  the  night,  but  not  incoherent;  much 
purged;  stools  bright  yellow;  pulse  116,  irregular,  not  much  power.  Pulv.  Ipec.  Co.  gr.  iij. 
4ta  honL 

7  P.M. — Quieter  than  usual ;  during  the  day  less  purged.     Pulse  124. 

loth. — Much  the  same;  pulse  120. 

1 7th. — Improved  in  appearance,  talkative,  but  still  irritable  in  temper  ;  appears  to  enjoy 
his  food;  pulse  116;  bowels  regular;  tongue  cleaning. 

18th. — Much  better;  countenance  natural;  pulse  104. 

19th. — Complains  of  pain  over  lower  part  of  belly.     Kept.  Emp.  Lyttae. 

20th. — Free  from  pain;  countenance  much  the  same;  pulse  130. 

21st. — Better  in  every  respect;   wishes  for  more  food,  and  to  get  up;  pulse  110. 

30th. — Is  up  to-day;  complains  only  of  weakness. 

June  15th. — He  was  presented  to-day,  quite  well.  It  was  quite  striking  the  difference  in 
his  language  and  manner.  His  language,  instead  of  being  rude,  foul,  and  abusive,  \vas  civil, 
respectful,  and  correct ;  his  manner  quiet,  instead  of  being  excited  and  snappish.  I  have 
no  doubt  whatever,  that  if  the  case  had  not  been  treated  as  one  of  inflammation  of  the 
hemispherical  ganglion,  but  had  been  passed  over  because  there  was  an  absence  of  the 
usual  symptoms  of  serious  injury  to  the  head,  the  boy  would  soon  have  been  decidedly  in- 
sane, and  then  the  same  measures  would  have  been  comparatively  useless.  It  cannot  be 
too  often  repeated  that,  when  once  the  delicate  texture  of  a  ganglion  is  in  an  acute  stage  of 
inflammation,  it  soon  becomes  disorganized,  and  all  medical  treatment  is  unavailing. 

The  following  short  case  illustrates  very  well  the  ordinary  course  of 
a  case  of  simple  concussion  of  a  slight  character,  though  the  primary 
effects  were  so  severe  that  the  existence  of  the  patient  was  in  danger : 

Case  19. — Wm.  Johnson,  a?t.  30,  gardener's  laborer,  stout,  hearty  looking  man,  was  driv- 
ing his  master's  cart  in  Bishopsgate-street,  December  18th,  1841.  The  day  was  cold,  and  he 
had  been  drinking  spirits  in  the  morning:  when  attempting  to  make  some  alteration  in  the 
harness,  he  fell  from  the  shaft,  pitching  on  his  head ;  the  wheel  went  over  his  pelvis  as  he 
lay  on  the  ground.  I  was  sent  for  to  see  him  a  few  minutes  after  the  accident,  in  Mr. 
Beale's  surgery,  Bishopsgate.  He  was  then  quite  insensible,  pulse  slow  and  distinct,  totally 
unconscious  of  everything.  On  examination  of  the  head,  I  found  a  spot  about  the  size  of  a 
crown,  over  the  superior  posterior  angle  of  the  left  parietal  bone,  puffed  and  swollen,  but  no 
irregularity  of  surface  indicating  fracture.  There  was  much  bruising  over  the  right  ilium, 
showing  the  course  of  the  wheel,  without  any  fracture  of  the  pelvis.  I  sent  him  down 
immediately  to  the  hospital.  I  saw  him  there  again  half  an  hour  after  the  occurrence  of 
the  accident;  he  now  shows  some  signs  of  returning  intellect  by  endeavoring  to  articulate 
his  wife's  name,  and  crying,  from  a  half  consciousness  of  his  situation,  but  he  could  not 
utter  any  distinct  articulate  sounds,  and  soon  sunk  into  a  quiet  insensible  state  again.  Or- 
dered Pulv.  Jalap,  c.  Hyd.  Chi.  gr.  xv.  stat.  M.  S.  C.  6ta  hora  postea.  Hirud.  xx.  capiti,  if 
his  pulse  got  up  in  the  evening,  and  the  dresser  thought  he  required  them. 

Dec.  19th. — Quite  rational;  vomited  about  two  hours  after  I  left.  Sister  considers  he  re- 
jected some  of  the  powder;  bowels  open;  leeches  not  applied.  Repeat  the  powder,  and 
as  he  complained  of  some  pain  on  the  left  side  of  the  head,  ordered  Hirud.  xx.  stat. 

20th. — Quite  well ;  permitted  him  to  leave  the  hospital. 

The  following  case  from  Mr.  Abernethy  shows  the  more  serious  effects 
of  concussion  : 

Case  20. — W.  Thomas,  about  30  years  of  age,  fell  from  the  top  of  a  brewhouse,  a  height 
of  at  least  80  feet.  His  hand  being  stretched  out,  first  sustained  the  shock,  by  which  the 


320  HUMAN   BRAIN. 

carpal  bones  were  separated,  and  driven  upwards,  some  before  and  others  behind  the  ends 
of  the  radius  and  ulna ;  the  articular  surfaces  and  periosteum  being  at  the  same  time  forced 
off  the  latter  bones.  I  mention  these  particulars  to  show  the  great  violence  of  the  fall. 
The  man's  head  afterwards  struck  the  ground,  as  appeared  by  a  bruise  on  his  face ;  but  the 
cranium  was  not  injured.  When  brought  to  the  hospital,  he  appeared  almost  deprived  of 
life,  his  body  being  cold  and  his  pulse  scarcely  to  be  felt.  The  gentlemen  then  attending 
put  his  feet  into  warm  water,  and  gave  him  an  opiate.  After  this  he  gradually  became 
warmer,  and  it  was  observed  that  there  was  not  much  dilatation  of  the  pupils,  and  but  little 
stertor  in  respiration.  I  saw  the  patient  next  morning,  at  which  time  his  skin  was  very 
hot,  and  he  perspired  copiously.  His  breathing  was  repeated  at  regular  intervals,  but  the 
expirations  were  made  with  unusual  force.  The  pulse  was  extremely  irregular,  both  in 
frequency  and  in  strength  ;  generally  about  140  in  a  minute.  His  pupils  were  moderately 
contracted,  his  eyebrows  drawn  into  a  frown,  as  if  he  suffered  pain.  When  I  spoke  to  him 
softly,  he  did  not  answer.  ^1  pinched  his  hand  slightly,  but  he  did  not  move  ;  but  when  I 
repeated  this  a  little  harder,  he  drew  it  away  with  seeming  vexation.  He  disliked  that  his 
eyes  should  be  examined.  When,  by  speaking  loud,  I  roused  him,  and  inquired  if  his 
head  ached,  he  answered  yes.  I  got  him  to  swallow  some  opening  medicine,  which  emp- 
tied his  bowels;  and  four  leeches  were  applied  to  his  temples,  but  they  extracted  very  little 
blood,  and  I  thought  his  pulse  countermanded  any  further  evacuations. 

In  the  afternoon  he  appeared  better.  His  pulse  was  more  regular,  and  his  skin  of  a  more 
natural  temperature ;  his  pupils,  however,  were  more  contracted,  and  his  sensibility  increased. 
I  tried  the  effect  of  giving  him  forty  drops  of  tinct.  opii,  thinking  it  might  diminish  sensibi- 
lity, and  keep  him  quiet  for  some  time,  during  which  the  vascular  system  (which  seemed  to 
be  particularly  deranged)  might,  perhaps,  regain  its  powers.  The  opiate  increased  his  dis- 
position to  sleep,  and  he  appeared  to  suffer  less  pain;  but  in  the  evening  his  pulse  was  more 
feeble  and  frequent,  and  his  skin  hotter,  and  quite  wet  with  perspiration.  Wine  was  now 
given  to  him,  but  without  any  apparent  benefit;  the  powers  and.  actions  of  life  gradually  di- 
minished, and  before  morning  he  died. 

On  dissection  there  appeared  every  mark  denoting  violent  inflammation  of  the  brain  and 
pia  mater.  The  minute  arteries  of  the  pia  mater  were  turgid  with  blood ;  in  many  places 
there  was  the  appearance  called  blood-shot,  which  was  also  to  be  seen  in  the  lining  of  the 
ventricles.  Dark  colored,  and,  in  some  places,  bloody,  coagulated  lyrnph  filled  all  the  re* 
cesses  between  the  tunica  arachnoidea  and  the  pia  mater.  On  dividing  the  substance  of  the 
brain,  all  its  vessels  appeared  as  if  injected  with  blood. 

I  am  inclined  to  believe  that  the  medical  treatment  of  the  patient  did  him  neither  much 
good  nor  harm.  The  means  employed  seem  to  have  acted  on  him  as  on  a  person  in  health. 
The  opening  medicine  rendered  him  cooler,  and  quieted  a  little  the  disturbed  actions  of  the 
system.  The  opiate  made  him  more  still,  and  disposed  him  to  sleep. 

I  leave  it  to  practitioners  to  consider  whether  cordials  would  have  been  of  any  service  in 
this  case.  Would  they  not  rather,  by  stimulating  the  nervous  system,  have  increased  the 
disturbance  of  the  sensorium,  and  by  exciting  the  heart  and  arteries,  have  tended  to  aggra- 
vate the  inflammation  of  the  brain  ? 

This  case  is  a  good  illustration  of  the  consequences  of  concussion 
when  the  disorder  is  uncontrolled  by  surgical  treatment.  Reasoning 
from  what  I  have  seen  in  other  cases,  I  cannot  but  think  that  if  the 
patient  had  been  freely  depleted  locally  and  mercurialized,  as  soon  as 
44  his  pupils  became  more  contracted,"  he  might  have  recovered. 

I  regard  this  condition  of  the  pupils,  taken  conjointly  with  a  hot  skin, 
as  a  very  clear  indication  of  the  commencement  of  inflammatory  mis- 
chief. 

I  regard  the  administration  of  opium  in  such  a  condition  as  decidedly 
injurious. 

Fractures  of  the  skull  more  frequently  than  mere  concussion  lead  to 
meningitis;  the  inflammatory  action  passing  continuously  from  the  bone 
and  its  periosteum  the  dura  mater,  to  the  arachnoid  and  pia  mater. 

The  following  case  marks  well  the  train  of  symptoms  which  I  believe 
indicate  inflammation  of  the  hemispherical  ganglion,  consequent  on  frac- 
ture of  the  skull. 


INFLAMMATION   OF   THE   DURA   MATER.  321 

Case  21. — Betsey  Rankin,  get.  18,  was  admitted  into  St.  Thomas's  Hospital,  under  my  care, 
as  Mr.  Travers'  assistant,  April  20,  1841. 

She  walked  down  to  the  hospital  with  her  mother,  and  came  to  the  surgery  as  a  casual 
patient.  Her  mother  stated  that  she  had  been  thrown  out  of  a  swing  at  Greenwich  fair,  a 
month  previously  to  her  admission;  that  she  was  stunned  at  the  time,  and  has  suffered  se- 
verely from  pain  in  the  head  since;  but  she  was  not  considered  severely  injured.  At  the 
time  she  presented  herself,  she  exhibited  an  unnaturally  excited  appearance  of  the  eye;  but 
her  answers  to  questions  were  perfectly  rational,  though  her  manner  was  rude  and  abrupt. 

One  of  my  colleagues  happening  to  see  the  case  immediately  after  she  was  in  bed,  before 
I  came  into  the  ward,  and  believing  it  to  be  his  own,  cut  down  upon  an  irregularity,  which 
he  found  upon  the  surface  of  the  skull;  the  pain  of  the  incision  made  her  very  violent  and 
disgustingly  abusive  in  her  language.  The  incision  permitted  the  escapeof  some  coagulated 
blood;  the  division  of  the  temporal  artery  gave  rise  to  a  free  haemorrhage  of  about  eight 
ounces.  It  exposed  a  fracture  extending  horizontally  through  the  parietal  to  the  frontal  bone, 
and  another  running  perpendicularly  from  the  above. 

11  p.  M.  Same  day.  Still  very  violent  and  abusive  in  her  language  when  •  spoken  to, 
otherwise  quiet  and  dozing;  tongue  foul;  pulse  quick.  I  explained  to  the  sister  of  the  ward 
that  her  violent  language  was  to  be  considered  as  a  symptom  of  disease,  and  that  everything 
was  to  be  effected  by  a  soothing  system  and  by  kindness.  This  was  scarcely  at  first  under- 
stood; but  my  directions  were  most  fully  carried  out,  and  their  value  afterwards  thoroughly 
appreciated.  When  I  saw  her,  I  ordered  Mist.  Sennas  Comp.  stat.  Hyd.  Chlorid.  gr1.  ij. 
quaque  tertia  hora. 

21st. — Bowels  freely  opened;  last  evacuations  watery.  Her  manner  is  still  excited;  but 
she  expresses  herself  much  relieved,  adding,  in  a  sharp  tone,  that  she  only  wanted  to  be  left 
quiet.  On  account  of  the  diarrhoea,  I  ordered  the  calomel  to  be  discontinued,  and  Hydr.  c. 
Creta  gr.  iij.  6ta  quaque  hora. 

22d. — As  the  bowels  are  now  quiet,  ordered  the  calomel  to  be  renewed;  she  is  rather 
more  rational. 

23d. — Bowels  relieved,  but  not  purged;  complains  of  pain  in  her  head,  which  is  un- 
naturally hot.  Ordered  twelve  leeches  to  be  applied,  if  the  sister  could  persuade  her  to  have 
them  on ;  but  not  to  use  any  violence. 

24th. — The  leeches  were  applied  without  much  difficulty ;  her  head  is  relieved,  and  she 
is  dozing  nearly  the  whole  day. 

27th. — I  made,  by  Mr.  Travers'  direction,  an  incision  at  right  angles  to  the  original  one ; 
this  caused  her  to  be  very  angry  and  violent. 

28th. — Better. 

29th — Much  better;  says  that  she  has  very  little  pain  in  the  head,  and  no  heat;  ordered 
a  little  fish.  Her  conduct  and  manner  to-day  were  quiet,  natural,  and  well-behaved.  I 
found  her  in  the  middle  of  the  day  sitting  up  in  her  bed,  knitting. 

May  1st. — As  she  was  not  quite  so  well  to-day,  exhibiting  some  of  her  previous  excited 
manner,  and  fearing  return  of  the  inflammation,  I  ordered,  as  I  did  not  think  her  constitu- 
tion would  bear  any  more  calomel,  aconite  gr.  ij.  t.  d.  Hirud.  xij. 

8th. — Pil.  Hydr.  gr.  v.  ter  in  die.  Quite  rational ;  says  her  head  is  quite  well,  the  wound 
healthy  and  discharging  freely. 

llth. — I  ordered  her  sarsaparilla  and  the  blue  pill  to  be  given  twice,  instead  of  three 
times  a-day.  The  aconite  was  also  omitted,  from  there  not  being  any  more  ready  at  the 
shop. 

12th. — Exceedingly  violent  and  excited  about  her  mother;  ordered  Hirud.  xij.  The  effect 
of  the  leeches  was  very  decided,  and  sleep  soon  followed  their  application. 

13th. — Manner  not  so  quiet  or  natural  as  previous  to  the  omission  of  the  aconite ;  ordered 
to  resume  the  aconite. 

This  last  medicine  was  continued,  with  small  doses  of  blue  pill,  until  the  29th,  when  she 
was  dismissed  quite  well.  Her  manner  was  modest  and  unassuming,  and  she  expressed 
herself  exceedingly  grateful  for  everything  that  had  been  done  for  her  in  the  hospital. 

The  surgeon  often  witnesses  inflammation  of  the  dura  mater,  seldom 
as  an  idiopathic,  or  spontaneous  disease,  but  generally  either  the  con- 
sequence of  syphilis  or  of  local  injury. 

Dr.  Watson*  considers  that  the  dura  mater  may  be  inflamed  while  the 
pia  mater  remains  unaffected  ;  and  that  the  arachnoid  may  suffer  inflam- 
mation and  leave  the  subjacent  pia  mater  untouched.  Whether  the 
arachnoid  ever  escapes  participating  in  the  inflammation  of  the  dura 

*  Lectures,  Med.  Gaz.,  vol.  xxvii.  p.  17Q. 

21 


322  HUMAN    BRAIN. 

mater  on  the  one  side,  or  the  pia  mater  on  the  other,  is  to  be  doubted. 
41  But  it  seems  to  me  scarcely  possible  that  inflammation  of  the  pia  mater 
should  take  place  without  implicating  also  the  surface  of  the  convolu- 
tions." 

I  agree  with  Dr.  Watson  in  his  opinion  regarding  inflammation  of  the 
dura  mater;  but  I  doubt  that  the  investing  portion  of  the  arachnoid  is 
ever  inflamed  without  the  pia  mater  being  more  or  less  implicated,  and 
with  it  the  hemispherical  ganglion.  I  have  long  felt  convinced  that 
there  is  no  such  thing  as  inflammation  of  the  pia  mater  independent  of 
the  brain,  and  that  much  mischief  has  accrued  from  our  systematic 
writers  treating  of  inflammation  of  the  membranes  of  the  brain  as  dis- 
tinct from  inflammation  of  the  brain  itself,  instead  of  distinguishing  be- 
tween inflammation  of  the  hemispherical  ganglion,  the  tubercular  portion 
beneath,  and  other  cerebral  ganglia. 

Dr.  Watson,  in  his  lectures,*  relates  the  following  case,  which  une- 
quivocally illustrates  his  opinion  that  inflammation  of  the  dura  mater 
may  be  confined  to  it,  and  the  reflected  portion  of  the  arachnoid,  and 
not  extend  to  the  pia  mater  or  brain. 

Case  22. — A  man  came  to  the  hospital  to  have  a  small  incised  wound  of  the  scalp  looked 
at.  The  injury  appeared  trivial ;  the  cut  was  dressed,  and  the  man  made  an  out  patient. 
A  few  days  afterwards  he  came  again  perfectly  paralytic  on  one  side  of  the  body.  I  saw 
the  man's  skull  trepanned ;  he  was  perfectly  calm  and  collected  :  that  part  of  the  dura 
mater  that  corresponds  to  the  wound  was  inflamed,  and  there  was  pus  effused  over  the 
arachnoid,  covering  the  cerebral  convolutions  on  the  same  side.  He  sank  quietly  into  a 
state  of  coma,  and  so  died.  Not  the  slightest  incoherence  or  delirium  had  been  mani- 
fested ;  there  had  been  no  convulsions,  nor  was  there  any  other  morbid  appearance  within 
the  cranium. 

Inflammation  of  the  dura  mater  sometimes  occurs  continuously  from 
the  petrous  portion  of  the  temporal  bone  and  the  lining  membrane  of 
the  internal  ear;  and  sometimes  without  any  disease  of  the  bone,  it  ex- 
tends along  the  sheath  of  the  auditory  nerve.  This  affection  is  not  un- 
common among  the  poorer  classes  and  those  whose  diathesis  isstrumous. 
It  occurs  more  frequently  in  childhood  than  in  either  adult,  or  old  age. 
Its  progress  is  very  gradual  and  insidious.  The  knowledge  that  such  a 
consequence  may  result  from  otitis  or  inflammation  of  the  internal  ear, 
should  make  us  very  careful  in  our  treatment  of  this  affection,  and  very 
guarded  in  our  prognosis.  I  have  found  that  the  best  treatment  in  such 
cases,  is  to  use  very  mild  and  unstirnulating  lotions,  and  even  these  very 
carefully  ;  counter-irritants  behind  the  external  ear,  and  anti-strumous 
medicines,  of  which  none  are  equal  to  the  cod-liver  oil. 

I  remember  having  a  case  of  chronic  otitis  under  my  care  at  the 
Aldersgate-street  Dispensary  for  some  weeks,  without  being  able  to 
effect  any  improvement  until  I  gave  her  the  cod-liver  oil.  She  recovered 
rapidly  with  this  medicine,  and  the  discharge  disappeared  without  any 
local  treatment. 

The  subject  of  the  following  case  I  saw  only  a  few  days  before  her 
death,  but  it  illustrates  the  insidious  and  fatal  character  of  the  disease. 

Case  23. — Otitis  terminating  in  abscess  of  the  cerebellum. — Phoebe  Whittington,  aged  5  years, 
had  had  an  occasional  discharge  from  the  ear  ever  since  her  birth ;  but  the  mother  yays,  that 
she  was  always  a  very  lively,  healthy-looking  child,  and  never  appeared  ill  until  seven  days 


Med.  Gaz.,  vol.  xxvii.  p.  771. 


INFLAMMATION   OF   THE   DURA   MATER.  323 

previous  to  my  seeing  her,  at  which  time  the  discharge  stopped,  and  she  then  complained  of 
ear-ache. 

I  first  saw  her  on  Wednesday,  the  17th  ;  she  then  looked  pale  and  in  pain,  but  not  diseased. 
I  discovered  a  small  fluctuating  turner  behind  the  right  ear,  over  the  temporal  bone,  about 
the  same  size  as  the  external  circumference  of  the  ear.  The  skin  was  not  discolored.  The 
head  was  violently  drawn  back,  and  the  sufferings  of  the  child  were  evidently  very  great. 
I  opened  the  swelling  with  a  lancet,  but  I  had  to  divide  it  very  deeply  to  reach  the  matter, 
as  no  absorption  of  integument  had  taken  place.  The  pus  was  excessively  foetid.  I  ordered 
a  simple  aperient.  The  following  day,  finding  the  child  but  little  relieved,  I  ordered  her 
small  doses  of  gray  powder  with  a  slight  sedative ;  but  she  remained  in  great  pain,  screaming 
violently  till  about  twenty  hours  before  her  death,  when  she  became  comatose,  and  died  just 
ten  days  after  the  invasion  of  these  fatal  symptoms. 

Post-mortem. — Cerebrum  presented  no  morbid  appearance ;  layer  of  pus  under  the  ten- 
torium;  abscess  in  the  cerebellum;  thickening  of  the  neurilemma  of  the  auditory  nerve, 
whole  sheath  filled  with  pus;  dura  mater  covering  the  posterior  face  of  the  petrous  portion 
of  the  temporal  bone  separated  from  it  by  pus.  The  surface  of  the  bone  not  carious,  only 
denuded. 

The  abscess  formed  a  thick  layer  on  the  centre  of  the  right  lobe  of  the  cerebellum,  occupy- 
ing, in  a  horizontal  plane,  nearly  the  whole  of  the  outer  circumference  of  that  lobe,  and  ex- 
tending across  the  mesial  line  a  little  way  into  the  left  lobe.  The  neurine  round  the  abscess 
was  not  altered  in  color  for  more  than  a  line  or  two  at  the  most. 

Labyrinth  of  the  ear  filled  with  pus,  and  the  whole  disorganized. 

I  considered  that  this  case  was  originally  one  of  inflammation  of  the  lining  membrane  of 
the  ear,  which  extended  along  the  neurilemma  of  the  nerve  to  the  cerebellum,  inasmuch 
as  the  temporal  bone  was  not  diseased,  nor  the  dura  mater  covering  it. 

Inflammation  of  the  dura  mater  may  spring  from  syphilis  in  two  ways; 
first,  and  most  commonly,  as  a  continuous  inflammation  from  a  diseased 
cranium  ;  secondly,  from  the  direct  action  of  the  poison,  as  in  other  fibrous 
tissues  and  periosteal  membranes  in  other  situations :  in  the  latter  instance 
it  assumes  much  of  the  rheumatic  character,  and  requires  to  be  treated 
like  rheumatism  in  other  parts  of  the  body,  only  more  actively. 

In  considering  the  hyperaBmic  affections,  and  the  effects  of  hypersemia 
of  the  dura  mater,  we  must  not  omit  osseous  deposits.  The  dura  mater, 
it  must  never  be  forgotten,  is  the  nutritive  membrane  of  bone.  Its  ves- 
sels sometimes,  like  vessels  in  other  situations  sometimes,  overdo  their 
duty,  and  the  bone  is  deposited  in  small  patches.  This  deposit  is  not 
confined  to  that  portion  which  lines  the  skull,  but  it  is  not  unfrequently 
found  on  the  falx  and  tentorium.  It  always  acts  more  or  less  as  an  irri- 
tating body. 

Case  24. — When  dressing  for  Mr.  Travers,  in  1823,  a  man  was  brought  under  my  care 
who  cut  his  throat  in  a  watch-house.  He  died;  and  when  we  were  making  an  examination 
of  his  head  in  the  dead-house,  on  mentioning  that  he  had  been  an  extremely  irritable,  violent- 
tempered  man  during  life,  frequently  illustrating  the  old  line,  "  Ira  furor  brevis  est,:'  Mr. 
South  said,  "  look  particularly  at  his  dura  mater,  and  see  if  there  are  any  osseous  deposits." 
In  this  case  there  were  rough  bony  deposits  on  the  falx  major. 

Since  then  I  have  frequently  remarked  the  same  connection  between 
this  morbid  growth  and  mental  irritability  amounting  to  insanity.  The 
following  is  one  among  many  others  which  I  might  detail : — 

Case  25. — J.  L.  had  been  peculiar  in  his  habits  and  manners  during  his  whole  life,  but 
latterly  it  became  necessary  to  place  him  in  an  asylum,  from  the  sudden  outbreaks  of  violent 
temper  over  which  he  apparently  had  no  control.  In  the  intervals  between  the  paroxysms, 
which  were  very  uncertain,  he  was  rational,  though  latterly  he  became  rather  imbecile.  The 
paroxysms  were  easily  excited  by  any  slight  circumstances  which  annoyed  him. 

He  sank  more  apparently  from  the  effect  of  the  intestinal  than  the  cerebral  disease. 

Post-mortem,  24  hours  after  death. — Weather  cool — March  1839. 

Skull. — External  appearances. — Supra-orbitar  region  fully  developed,  frontal  region  rather 
small,  occipital  and  posterior  parietal  full  and  large. 


324  HUMAN   BRAIN. 

The  bones  generally  much  thinner  than  usual,  especially  in  the  frontal  and  temporal 
regions. 

Dura  Mater. — External  surface  healthy ;  ossific  deposits  on  its  visceral  surface.  These 
were  three  in  number,  situated  very  near  to  the  longitudinal  sinus  on  the  right  side;  the 
most  anterior  of  which  was  situated  opposite  the  coronal  suture,  about  the  size  of  a  large 
pea,  but  with  sharp,  irregular-pointed  edges ;  the  next,  about  an  inch  behind,  the  form 
of  the  letter  Y,  about  an  inch  in  length,  an  eighth  of  an  inch  wide,  very  rough ;  the  pos  • 
terior  patch  was  much  like  the  anterior. 

Cerebro-spinal  fluid  in  very  large  quantities  under  the  arachnoid.  The  convolutions 
on  the  upper  part  of  the  anterior  lobes  slightly  atrophied,  their  surfaces  pinched  up,  and 
the  fossae  wide. 

Cerebellum  full  and  large. 

In  tearing  off  the  pia  mater,  portions  of  the  hemispherical  ganglion  were  removed  with 
it,  in  consequence  of  some  softening  of  its  texture,  more  particularly  in  the  neighborhood  of 
the  osseous  deposits. 

Three  layers  of  cineritious  neurine  were  distinctly  visible  in  this  ganglion.  The  external, 
the  darkest ;  the  middle,  the  lightest  in  color ;  the  most  internal,  the  next  in  tint  to  the 
external.  The  white  fibres,  running  through  them,  were  beautifully  distinct. 

Chest.— Viscera  healthy. 

Abdomen. — Flatulent  distension  of  the  colon ;  ulceration  of  the  mucous  membrane  of  the 
ilium,  close  to  the  ilio  caecal  valve. 

The  extreme  thickness  of  the  skull,  which  is  not  unfrequently  met 
with  in  insane  patients,  must  be  regarded  as  the  result  of  long-continued 
and  general  hypersemia  of  the  dura  mater. 

The  spiculse  of  bone  which  are  found  sometimes  shooting  from  the  in- 
ternal surface  of  the  skull,  though  scarcely  coming  into  this  category, 
deserve  mention  here.  There  is  generally  an  abnormal  development 
of  normal  projections ;  we  meet  with  them  not  unfrequently  springing 
from  the  temporal  and  parietal  bones  in  the  temporo-sphenoidal  fossae. 
I  have  seen  them  in  cases  where  they  have  evidently  lacerated  the  brain 
after  a  severe  blow  has  been  struck  on  the  skull.  The  brain,  in  such 
cases,  is  shaken  violently  and  moved  within  the  skull,  so  that  the  sharp 
projecting  spiculum  is  jerked  out  of  the  fossa  in  the  brain  in  which  it 
lies  quietly  at  rest,  and  lacerates  the  brain  on  the  side.  The  following 
case  illustrates  this,  and  also  organic  disease,  in  connection  with  which 
subject,  I  shall  again  have  occasion  to  refer  to  it. 

The  anterior  and  posterior  clinoid  processes  are  not  unfrequently  so 
abnormally  developed  that  they  act  as  irritating  extraneous  bodies.  They 
have  frequently  been  considered  as  the  proximate  cause  of  epilepsy,  and 
they  have  certainly  been  often  found  diseased  in  this  formidable  com- 
plaint. I  had  the  opportunity  of  making  a  post-mortem  examination  in 
the  following  case,  through  the  kindness  of  my  friend,  Mr.  Ebenezer 
Smith,  of  Billiter  Square. 

Case  26. — E.  W.,  aged  thirty-two,  suffered  from  epilepsy  since  she  was  twelve  years  of 
age.  The  first  attack  followed  a  blow  on  the  back  part  of  the  head,  occasioned  by  a  fall ; 
latterly  the  fits  occurred  very  frequently,  four  or  five  times  in  the  night,  with  an  occasional 
interval  of  four  or  five  days.  Her  temper  was  excessively  irritable,  and  her  mind  had  gra- 
dually become  imbecile.  She  died  during  the  fit,  apparently  in  a  state  of  asphyxia. 

Post-mortem. — Sub-fascial  cellular  tissue  of  the  cranium  abnormally  vascular  and  firm. 
Bones  of  the  skull  vascular,  compact,  and  thick,  particularly  at  the  centres  of  ossification 
in  the  frontal  and  parietal  bones. 

The  frontal  bone  in  the  mesial  line  thin.  Vessels  of  the  dura  mater  enormously  dis- 
tended; bled  very  freely  on  separating  it  from  calvarium.  Arachnoid  slightly  opaque. 
Vessels  of  pia  mater  very  full  of  blood.  Fossae  digitate  between  the  convolutions  in  the 
parietal  and  frontal  regions  large ;  cerebro  spinal  fluid  abundant.  Cortical  substance  of  the 
cerebellum  rather  darker  than  usual;  the  medullary  more  vascular;  the  whole  rather  soft. 
On  making  a  section  of  the  centrum  ovale,  we  were  struck  with  the  distinctness  of  the  line 


INFLAMMATION   OF   THE   DURA   MATER.  325 

of  demarkation  between  the  cortical  and  medullary  substance,  both  of  which  were  very- 
vascular  ;  softening  of  the  fornix.  Choroid  plexus  large,  and  almost  fleshy.  In  the  right 
temporal  sphenoidal  fissure  we  found  an  abnormally  developed  mammillary  process,  about 
the  sixth  of  an  inch  in  length,  sharp  at  its  point,  but  wide  and  broad  at  its  base,  projecting 
like  a  spine  from  the  squamous  portion  of  the  temporal  bone  ;  and  on  the  middle  lobe 
of  the  brain,  corresponding  to  this  projection,  there  was  distinct  softening  of  the  cortical 
substance. 

No  other  cavity  examined. 

Inflammation  of  the  dura  mater  must  always  be  treated  actively.  If 
it  is  not  arrested  in  an  early  stage,  it  soon  runs  on  to  the  other  mem- 
branes, and  thence  to  the  hemispherical  ganglion.  Sometimes  it  stops 
short  of  the  brain,  but  causes  fatal  effusion  from  the  arachnoidal  surface. 

The  following  shows  the  disease  advancing  from  syphilitic  affection 
of  the  cranium.  I  had  the  case  under  my  care  in  Job's  Ward,  St. 
Thomas's  Hospital. 

Case  27. — The  patient,  named  Hawkins,  had  not  long  been  suffering  from  secondary 
syphilis.  He  had  been  in  the  house  some  months  before  he  came  under  my  care.  He  had 
necrosis  from  nodes  of  portions  of  the  frontal  and  parietal  bones,  but  without  any  symptoms 
of  cerebral  disease,  or  even  irritation. 

I  happened,  however,  to  remark  to  the  pupils,  that  such  cases  were  not  unattended  with 
danger,  as  inflammation  of  the  dura  mater,  arachnoid,  arid  pia  mater,  sometimes  suddenly 
supervened,  and  that  the  patient  would  then  sink  from  such  effusion ;  about  two  days  after 
this  I  was  called  to  him,  in  consequence  of  his  becoming  drowsy  and  stupid :  when  I  arrived 
I  found  him  not  quite  insensible,  but  scarcely  able  to  answer  any  question  when  roused,  and 
when  left  undisturbed,  he  was  in  a  semi-comatose  condition.  I  immediately  ordered  five 
grains  of  calomel  every  four  hours,  a  blister  to  the  back  of  the  neck,  and  to  be  dressed  with 
the  strong  mercurial  ointment;  he  got  rapidly  worse,  and  soon  became  quite  insensible ;  but 
in  twenty-four  hours  the  mercury  began  to  take  effect,  and  it  was  most  delightful  to  see  the 
rapidity  with  which  the  cloud  was  again  removed  from  his  intellects ;  in  forty-eight  hours 
he  was  sensible  enough  to  answer  questions,  and  ultimately  quite  recovered.  It  was  also 
interesting  to  observe  an  immense  improvement  in  all  his  syphilitic  symptoms.  His  nodes 
became  healthy,  and  some  large  rupial  sores  which  he  had  on  his  thighs  and  legs  began  to 
heal,  and  progressed  most  favorably.  Previously  to  this  attack,  he  had  been  taking  the  iodide 
of  potassium  and  sarsaparilla,  and  a  generous  diet. 

Inflammation  of  the  dura  mater,  followed  by  fatal  effusion,  sometimes 
arises  from  traumatic  necrosis  of  the  cranium. 

Case  28. — On  the  19th  of  January,  1843,  a  seaman,  of  the  name  of  John  Richardson,  was 
admitted  into  Abraham's  Ward,  St.  Thomas's  Hospital,  under  the  care  of  Mr.  Tyrrell.  He 
was  34  years  of  age;  he  had  an  extensive  sore  on  the  forehead,  at  the  bottom  of  which 
there  was  a  large  piece  of  blackened  dead  bone.  The  appearance  presented  was  so  cha- 
racteristic, that  I  had  a  drawing  made  of  it  immediately. 

He  stated  that  he  had  received  a  blow  on  the  forehead,  from  a  piece  of  log-wood,  when 
in  the  ship's  hold,  six  years  previous  to  his  admission ;  he  was  stunned  by  the  blow,  and  had 
not  been  fit  for  much  hard  work  since.  On  admission,  he  complained  of  pain  in  his  head, 
but  there  were  no  symptoms  of  any  cerebral  mischief. 

The  treatment  during  the  short  time  he  was  in  the  hospital,  for  he  only  survived  seven 
days,  was  alterative  medicines  internally,  and  poultice  to  the  wound. 

On  the  evening  of  the  seventh  day  after  his  admission,  a  sudden  change  took  place,  the 
discharge  from  the  wound  stopped,  and  the  offensive  smell  ceased ;  he  became  insensible, 
and  sank,  quite  comatose,  about  five  the  next  morning. 

There  was  no  raving,  no  delirium,  slight  muttering,  as  if  he  were  scolding  somebody. 
From  the  commencement  of  these  symptoms  he  was  never  sufficiently  conscious  to  answer 
any  questions. 

No  post-mortem  examination. 

I  have  seen  in  the  venereal  wards  of  our  hospital  rheumato-syphilitic 
inflammation  of  the  dura  mater  pass  on  to  the  brain  and  produce  in- 
sanity. The  following  case  is  a  good  illustration  of  it,  and  the,  value  of 
active  treatment : — 


326  HUMAN    BRAIN. 

Case  29. — Henry  Glazier,  set.  25,  a  bricklayer,  of  unhealthy  aspect,  pale  complexion,  and 
spare  frame  of  body,  was  admitted  under  my  care,  as  Mr.  Green's  assistant,  into  Job's  Ward, 
on  the  1st  of  February,  with  iritis  and  secondary  eruptions,  for  which  calomel  and  opium 
were  administered,  so  as  to  affect  the  mouth,  and  he  rapidly  improved.  He  appeared  to  be 
in  his  usual  good  health  till  Wednesday,  when  the  sister  observed  something  sharp  in  his 
manner,  and  a  wild  expression  of  countenance.  The  same  morning  he  left  the  ward  with- 
out his  hat  and  coat,  and  remained  out  the  whole  of  the  day,  the  weather  being  very  cold 
and  wet;  he  returned  in  the  evening,  and  complained  of  pain  in  all  his  limbs;  it  was  found 
that  his  knees  and  ankles  were  swollen  and  red;  he  passed  a  sleepless  night,  frequently 
changing  his  position  in  bed,  and  occasionally  crying  out  with  a  loud  voice.  On  the  follow- 
ing day  the  joints  were  free  from  all  swelling;  the  man,  however,  when  questioned  as  to 
pain,  complained  of  headache ;  the  expression  of  his  countenance  was  vacant,  wild,  and 
suspicious;  he  said  that  he  had  committed  some  crime,  and  that  he  ought,  therefore,  not  to 
lie  in  bed,  and  it  was  with  difficulty  that  he  could  be  prevailed  upon  to  do  so  ;  he  refused  to 
take  any  nourishment  or  medicine,  but  he  answered  questions  that  were  put  to  him  quite 
correctly,  though  during  the  day  he  was  sometimes  so  obstinately  silent  that  no  answers 
could  be  elicited  from  him.  The  pulse  was  quick,  but  soft  and  compressible ;  the  tongue 
furred  and  moist ;  the  heat  natural ;  the  bowels  open  ;  no  intolerance  of  light  or  sound.  I 
told  the  pupils  that  I  considered  the  man  was  suffering  from  inflammation  of  the  mem- 
branes of  the  brain,  caused  by  metastasis  from  the  sudden  recession  of  rheumatic  inflamma- 
tion. 

It  appears  that  the  habits  of  the  patient  have  always  been  regular  and  temperate ;  none 
of  his  family  have  suffered  from  insanity.  He  was  ordered  Pulv.  Jalapse  c.  Cal.  £)j.  M.  S. 
C.  Liq.  Amm.  Acet.  ^fs.  Vin.  Colchici  TT^xl.  Mag.  Carb.  £)  j.  Aq.  Menth.  Pip.  6''"  horis.  Vene- 
sectio  ad  ^viij.  Cal.  gr.  v.  4tlS-  horis. 

28th. — On  the  following  day  he  was  quiet  and  composed ;  he  no  longer  refused  to  take  his 
food  or  medicine,  and  he  said  the  headache  was  better.  The  same  afternoon,  however,  the 
symptoms  returned,  and  he  was  inclined  to  be  violent.  The  bowels  had  acted  freely. 

Ordered  Emp.  Lyttse  nuchse.  Ung.  Hydrarg. 

B.  Aconite  gr.  j.  Hyd.  c.  Greta  gr.  v.  6''"  horis. 

Morphise  Hydrochlor.  gr.  j.  o.  n. 

Ext.  Colchici.  gr.  iij.  6tis-  horis. 

March  1st. — Appears  to-day  quite  comfortable;  the  countenance  is  nearly  natural,  and  he 
passed  a  good  night;  he  makes  no  complaint. 

4th. — He  has  continued  improving  daily  since  the  last  report ;  he  now  appears  to  be  per- 
fectly rational,  and  he  sleeps  well. 

Ordered  Hyd.  c.  Creta  gr.  ij.  6tls-  horis.     Beef  tea,  Vin.  Colchici  TT^xx. 

No  change  occurred  in  this  patient's  progress ;  he  perfectly  recovered,  and  went  out  quite 
well. 

I  have  no  doubt  that  chronic  inflammation  of  the  dura  mater  is  a  very 
frequent  cause  of  insanity.  The  skull  is  so  frequently  found  thickened 
and  vascular,  as  well  as  the  arachnoid,  after  death  in  these  cases,  that 
the  condition  of  the  skull  should  always  be  noted  in  seeking  for  morbid 
lesions  to  account  for  irritation  of  the  hemispherical  ganglion. 

I  have  selected  the  two  following  cases  from  many  which  I  inspected 
at  Hanwell.  The  facts  are  interesting  in  a  phrenological  point  of  view, 
though  of  course  they  prove  nothing  unless  they  are  supported  by  many 
such  cases.  It  has  not  fallen  to  my  lot  to  observe  others  in  support  of 
the  phrenology  of  the  subject,  but  I  give  these,  as  I  recorded  them  at 
the  time. 

Case  30. — Thickness  of  the  os  frontis  producing  melancholia. — Hanwell,  March  2d,  1841. — 
Death  from  fever  supervening  on  melancholia,  during  which  the  patient  was  almost  con- 
stantly crying  and  moaning ;  she  could  vonly  make  incoherent  replies.  During  the  febrile 
excitement  she  occasionally  gave  distinct  answers,  and  protruded  her  tongue  when  re- 
quested. 

History  of  case  unknown. 

Post-mortem. — 28  hours.     Body  much  emaciated. 

Cranium  exceedingly  thick  in  the  frontal  region,  especially  over  the  organs  of  mirth  ful- 
ness, ideality,  and  hope,  where  it  was  nearly  a  quarter  of  an  inch  in  thickness,  as  proved  by 
perforating  it  with  a  gimlet,  and  measuring  the  section.  The  rest  of  the  skull  was  slightly 


INFLAMMATION    OF    THE    DURA    MATER.  327 

thicker  than  natural,  especially  the  anterior  portions  of  the  parietal  bone,  as  shown  by  the 
great  depth  oi'  the  arterial  ibs^ae. 

Brain. — Fibrous  neurine  more  vascular  than  natural.  Cineritious  substance  of  the  ante- 
rior convolutions  decidedly  darker  than  natural,  and  much  more  so  than  the  posterior. 

Weight  of  brain  and  cerebellum,  2  Ibs.  13  oz. 

Lung.— One  tubercle,  in  the  lower  portion  of  upper  lobe  of  right  lung. 

Liver. — Peritoneal  covering  slightly  thickened  by  white  deposit.  Pancreas  firmer  than 
usual. 

Remarks. — I  consider  that  in  the  preceding  case,  the  disease  commenced  with  chronic  in- 
flammation of  the  dura  mater,  covering  the  anterior  part  of  the  brain,  producing,  as  in  ordi- 
nary cases  of  periostitis,  gradual  thickening  of  bone,  and  that  the  thickened  bone,  pressing 
on  the  organs  of  ideality,  mirthfulness,  and  hope,  and  partially  on  the  reflective  organs  also, 
gave  rise  to  the  peculiar  form  of  insanity — melancholia.  The  absence  of  all  appearance  of 
maniacal  excitement  was  to  be  accounted  for  by  the  absence  of  all  appearance  of  inflamma- 
tion of  the  arachnoid  and  pia  mater.  It  is  very  much  to  be  regretted  that  there  was  no 
early  history  of  the  case,  either  as  regards  the  probable  cause  of  the  disease  or  its  progress. 

The  following  case,  derived  from  the  same  source,  appears  to  me 
confirmatory  of  this  view  : — 

Case  31. — Han  well,  April  1st,  1841. — John  Buckingham,  set.  48.  Insane  ten  years  Men- 
tal imbecility  supervening  on  anxiety. 

Post-mortem. — 37  hours. 

Head. — Skull  generally  thick  at  the  anterior  part ;  arterial  fossse  numerous  and  rather 
deep.  In  the  centre  of  the  frontal  bone  it  was  two-filths  of  an  English  inch  in  thickness  (4 
French  lines).  Dura  mater  strongly  adherent  to  the  skull. 

Brain. — Cortical  substance  pale,  softening  of  that  portion  of  the  longitudinal  commissure 
called  the  septum  lucidum. 

Weight  of  cerebrum  and  pons,  3  Ibs.  6  oz.     Cerebellum  and  medulla  6  oz. 

Death  from  excited  hydrothorax,  atrophy  of  right  ventricle  of  heart,  disease  of  liver. 

Sometimes  these  cases  are  most  obstinate  and  obscure. 

Case  32. — I  had  under  my  care  a  poor  fellow,  in  the  venereal  wards  of  the  hospital, 
whose  sufferings  were  excessive.  When  1  first  prescribed  for  him  I  did  so  under  the  belief 
that  he  had  this  form  of  inflammation,  but  finding  that  all  the  remedies  which  I  have  ordi- 
narily found  successful  in  the  treatment  of  these  cases,  such  as  mercury,  leeches,  and  the 
iodine  of  potassium,  entirely  fail,  I  thought  T  must  have  mistaken  the  case ;  and  as  there 
were  no  cerebral  symptoms,  I  ventured  to  prescribe  for  him  such  medicines  as  are  benefi- 
cial in  neuralgia,  but  without  any  improvement.  Having  failed  in  all  my  endeavors  to  alle- 
viate his  sufferings,  I  got  one  of  our  physicians  kindly  to  take  him  under  his  care,  who  sali- 
vated him  most  freely ;  but  he  kept  getting  worse,  at  last  becoming  paralyzed  on  one  side 
of  his  face,  and  totally  deaf.  The  disease,  however,  stopped  here.  He  did  not  lose  his  in- 
tellect, or  become  more  paralytic. 

Among  the  causes  of  inflammatory  affections  of  the  brain  we  must  not 
omit  the  poison  of  scarlatina. 

Sometimes  the  brain  is  attacked  in  the  first  instance,  before  the  erup- 
tion appears;  and  sometimes,  the  eruption  not  appearing  at  all,  the  na- 
ture of  the  case  is  misunderstood.  I  knew  one  family  in  which  three 
children  were  carried  off,  in  the  course  of  a  few  days,  with  cerebral 
symptoms,  which  could  not  be  accounted  for  until  the  fourth  child  ex- 
hibited the  true  eruption  of  scarlatina.  In  these  cases  depletion  must 
not  be  attempted,  but  everything  to  determine  the  poison  to  the  skin. 

The  sequelae  of  scarlatina  are,  however,  every  now  and  then  most  for- 
midable in  relation  to  the  brain.  Every  practitioner  has  seen  these 
cases.  The  patient  is  apparently  recovering  from  a  mild  attack  of  scar- 
latina, when  suddenly  he  is  seized  with  headache  and  blindness,  with  or 
without  convulsions.  These  symptoms  may  have  been  preceded  by  the 
anasarca  which  frequently  follows  scarlatina,  and  on  that  account,  says 
Dr.  Abercrombie,  "  are  apt  to  be  ascribed  to  sudden  effusion  in  the 


328  HUMAN    BRAIN. 

brain  ;  but  the  disease  is  entirely  inflammatory,  and  the  patient  can  be 
saved  only  by  the  most  vigorous  treatment,  by  blood-letting,  purgatives, 
and  other  similar  remedies."  It  should,  indeed,  be  borne  in  mind  that 
all  the  sequela  of  scarlatina  are  inflammatory  ;  the  anasarca  quite  as 
much  so  as  any  other. 

Inflammation  of  the  Hemispherical  Ganglion  from  within. — There  is 
perhaps  no  single  cause  which  so  frequently  produces  inflammation  of 
the  hemispherical  ganglion  or  meningitis  as  sudden  emotion,  whether  of 
joy  or  fear.  The  latter  is,  however,  much  more  common.  Dr.  Aber- 
crombie  and  Andral  relate  several  cases.*  The  remedial  treatment 
should  be  physical,  though  the  cause  is  metaphysical;  moral  treatment 
alone  will  not  arrest  inflammatory  action. 

The  pathological  state  must  not  be  lost  sight  of  on  account  of  the 
metaphysical  state. 

When  inflammation  of  the  hemispherical  ganglion  is  excited  by  moral 
impressions,  the  existing  cause  of  the  attack  travels  through  the  nerves 
of  sense  from  without  inwards,  centripetally.  It  ought  to  be  distin- 
guished from  those  attacks  which  are  induced  by  external  causes,  such 
as  those  wre  have  just  been  considering. 

The  following  cases  will  illustrate  what  I  mean  by  inflammation  of 
this  ganglion  from  within — inflammation  induced  by  impressions  carried 
to  the  brain  by  the  nerves  of  sense,  giving  rise  to  unnatural  and  undue 
action  of  the  organ. 

In  the  second  of  these  two  cases  I  believe  that  the  inflammation  was 
of  a  very  low  and  feeble  character,  not  confined  to  this  ganglion,  but 
extending  to  the  tubular  substance  and  lining  membrane  of  the  ventri- 
cles, and  accompanied  by  some  serous  effusion. 

Case  33. — Inflammation  of  hemispherical  ganglion  produced  by  fright. — On  the  2d  of  June, 
1842,  I  was  called  by  Mr.  Wildbore,  of  Shoreditch,  to  visit  Miss  E.  R,  who  was  suffering 
from  cerebral  symptoms.  I  found  her  lying  in  bed;  countenance  pale  and  anxious;  pupils 
dilated,  and  sluggish  to  the  stimulus  of  light.  When  I  first  inquired  if  she  had  pain  in  the 
head,  she  said  no;  but  after  she  had  raised  herself  and  lain  down  again, she  complained  of 
violent  pain;  pulse  84,  and  small;  head  hot;  tongue  furred,  but  not  dry;  understands  what 
is  said  to  her,  but  answers  slowly. 

History. — She  was  a  nervous  person  when  in  health,  and  naturally  rather  irritable  and  ex- 
citable. She  went  to  Greenwich  fair  unknown  to  her  parents,  and  therefore  concealed  her 
illness.  When  at  the  fair  she  was  suddenly  pushed  by  a  stranger  to  make  her  run  down 
the  hill.  She  fell,  was  not  hurt,  but  much  frightened,  and  made  excessively  angry.  She 
was  menstruating  at  the  time.  She  continued  to  cry  and  sob  hysterically  for  seven  or  eight 
hours  afterwards,  and  for  three  weeks  she  seemed  to  brood  over  it,  getting  gradually  worse. 
She  would  not  complain ;  but  her  sister  remarked  that  her  head  was  drawn  back.  When 
asked  why  she  did  so,  she  said  it  was  so  heavy.  She  also  became  silly  in  her  expressions, 
excessively  irritable,  sullen,  and  taciturn.  She  said  that  when  her  head  was  on  the  pillow, 
she  could  not  raise  it  again  ;  she  also  complained  that  everything  she  saw  became  double  its 
size,  and  fiery;  when  lying  in  bed  she  would  scream  out  that  she  was  falling. 

Considering  from  the  symptoms  and  previous  history,  that  the  case  was  one  of  meningitis, 
we  ordered  Hydrarg,  proto-iodide  gr.  j.  and  a  large  blister  with  60  leeches  to  her  head. 

2d  day,  ^  past  9  A.M. — Has  not  slept  much  during  the  night;  complained  a  good  deal  of 
her  head;  pupils  very  much  dilated;  anxious  when  spoken  to,  but  every  now  and  then 
jumps  up,  and  cries  out,  as  if  frightened;  complains  of  her  head,  and  pain  in  the  ball  of  the 
eye;  says  to  those  about  when  speaking  in  their  ordinary  tone,  "Don't  holloa  so;"  shows 
immense  muscular  power  in  her  arms.  Emp.  Lytta?  to  be  dressed  with  mercurial  ointment, 
and  as  there  was  difficulty  in  getting  her  to  take  pills,  we  substituted  Hyd.  bichlorid.  gr. 
Tlff  4ti8  hor.  in  mint  water.  Hirud.  xx.  to  the  head. 


Dr.  Prichard  (op.  cit.,  p.  371)  makes  some  interesting  obseivations  on  this  subject. 


INFLAMMATION   OF   THE   HEMISPHERICAL   GANGLION.  329 

10  P.M. — Has  been  much  quieter,  and  apparently  more  easy,  after  the  application  of  the 
leeches. 

The  same  principle  of  treatment  was  carried  out,  and  she  ultimately  recovered,  but  it  was 
ten  weeks  before  she  was  well,  and  her  memory  has  been  deficient  ever  since.  She  did 
not  menstruate  for  four  months. 

Case  34. — Nervous  fever  succeeding  to  natural  labor,  after  many  days'  congestion  of  the  brain 
supervening,  unth  probable  effusion. — C.  J.  B.,  a-t.  30,  the  wife  of  a  medical  man  in  the  coun- 
try, was  delivered  of  her  fourth  child,  January  2d,  184-,  after  an  easy  and  natural  labor 
of  six  hours.  The  child  was  large,  and  she  being,  to  use  a  common  and  well-understood 
term,  constitutionally  weak,  her  husband  gave  her,  towards  the  completion  of  delivery, 
about  an  ounce  of  sherry  in  a  little  hot  water,  at  short  intervals,  the  effect  of  which  stimulus 
was  obvious  in  expediting  the  expulsion  of  the  head. 

Having  lost  by  death  her  preceding  infant  at  the  age  of  eleven  weeks,  from  some  con- 
genital defect  in  the  organs  of  circulation,  she  was  now.  and  had  been  heretofore,  acutely 
anxious  about  the  welfare  and  survival  of  the  present  child.  Her  former  nurse,  a  decided 
favorite,  had  been  ailing  for  some  weeks,  and  it  had  been  doubtful  whether  she  would  be 
able  to  wait  upon  her  at  this  period.  On  this  point  the  patient  had  been  solicitous,  more  for 
the  child's  sake  than  her  own,  as  she  naturally  enough  believed  that  no  other  person  could 
take  the  same  care,  or  do  equally  well.  The  nurse,  however,  now  attended,  much  to  her 
patient's  delight. 

The  after  pains  were  more  severe  than  before,  and  for  this  reason  the  liquor  opii  sed.  was 
given,  and  repeated  more  frequently,  together  with  some  hyoscyamus  and  morphia,  during 
the  two  first  days.  They  did  not,  however,  succeed  in  procuring  much,  or  good,  sleep,  and 
induced  a  numbness  in  the  hands  and  face,  which  rather  alarmed  so  timid  a  patient.  With 
this  exception,  and  the  circumstance  of  there  being  (as  on  the  two  last  similar  occasions), 
considerable  relaxation  of  skin,  evinced  by  copious  and  warm  perspiration,  everything  went 
on  as  satisfactorily  as  could  be  desired  for  three  days  immediately  following  her  delivery. 
Some  little  mental  disquietude  was  yet  perceptible,  at  the  nurse  displaying  signs  of  severe 
illness.  Lactation  was,  nevertheless,  very  good,  as  also  was  the  lochial  discharge;  and  ape- 
rient medicine  had,  to  all  appearance,  its  proper  effect  upon  the  bowels.  The  child  was 
very  healthy,  and  afforded  no  cause  for  extra  attention. 

We  now  arrive  at  a  particular  point  of  our  patient's  history.  Early  on  the  fifth  day  the 
nurse  announced  to  her  that  she  was  compelled,  from  increasing  infirmity  and  suffering,  to 
give  up  her  situation.  This,  in  the  patient's  own  words,  "gave  her  quite  a  turn."  The  best 
substitute  that  could  be  found  was  obtained,  but  she  was  a  woman  of  inferior  intelligence, 
and  wanting  in  the  art  of  pacifying  the  child  as  readily  as  her  predecessor.  Not  being  also 
similarly  expert  in  the  various  little  offices  incidental  to  the  lying-in  chamber,  and  those 
which  the  patient  requires  from  her  monthly  attendant,  she  failed  at  first  to  inspire  much 
confidence;  and  it  may  be  here  added,  that  she  gave  no  better  satisfaction  afterwards.  No 
bad  consequence  was,  however,  yet  observable;  for  during  the  three  or  four  subsequent  days 
the  patient  began  to  take  light  animal  food  and  broths,  as  she  had  usually  done — one  day 
partaking  of  partridge,  another  of  pheasant,  and  the  third  of  hare,  whilst  on  the  tenth  day 
she  was  allowed  about  ^iv  of  porter,  and  a  mutton  chop;  of  the  latter  she  ate  scarcely  half, 
but  enjoyed  her  porter.  During  the  intermediate  days  (from  the  fifth,  namely  to  the  tenth) 
she  had  not  slept  well,  disturbed  partly  by  the  child's  crying,  but  excited  rather  from  this 
circumstance,  by  want  of  confidence  in  the  fresh  nurse,  which  feeling  had  been  gradually 
growing  upon  her,  although  the  cause  was  really  more  in  her  own  fears  than  from  incapa- 
bility on  the  part  of  the  woman. 

On  the  15th  of  January,  this  state  of  nervous  irritability  had  much  increased,  every  cry 
of  the  child  seeming  to  aggravate  it,  so  that  the  nurse  and  child  were  removed  to  another 
room,  but  without  ultimately  producing  any  improvement  in  the  matter.  All  matters  con- 
nected with  the  uterus  were  quite  satisfactory.  There  was  no  abdominal  or  hypogastric 
tenderness.  The  lochial  discharge  was  naturally  subsiding,  but  had  not  ceased  altogether. 
The  milk  was  certainly  diminished,  but  not  more  than  might  have  been  expected  from  the 
diminution  of  nutriment,  in  consequence  of  the  total  loss  of  appetite  which  had  ensued.  She 
both  experienced  and  expressed  great  fatigue  in  nursing  the  child,  which,  as  was  to  be  ex- 
pected, was  not  satisfied. 

After  this  period,  anorexia  persisted,  along  with  nausea  and  tendency  to  sickness,  and 
there  was  considerable  derangement  in  the  excretions  from  the  bowels.  One  or  two  grains 
of  calomel,  carried  off  by  half-ounce  doses  of  senna  mixture  (her  ordinary  quantum),  brought 
away,  in  seeming  plenty,  disordered  stools  to  the  amount  of  four  or  five  each  time.  Still, 
the  impression  was  strong  upon  her  mind  that  the  bilious  matters  required  more  calome). 
The  pulse  had  varied  from  110  even  to  140,  evidently  kept  up  by  mental,  or  more  properly 
nervous,  excitement.  The  perspirations  had  subsided,  but  an  undue  temperature  of  the  skin 
complained  of,  which  was  also  sensible  to  the  touch;  the  tongue  exhibited  posteriorly  a 


330  HUMAN   BRAIN. 

rough  white  fur,  though  not  thick;  some  thirst;  there  was  frequent  headache,  not  of  long 
continuance,  attended  by  a  feeling  of  faintness.  She  had  taken  no  sustenance  besides  gruel 
and  tea,  with  a  very  small  quantity  of  bread  and  butter,  or  biscuit;  as  other  substances,  even 
weak  broth,  gave  rise  to  most  unpleasant  heat,  in  addition  to  their  being  loathed.  Under 
these  circumstances,  I  prescribed  the  Hydr.  c  Greta,  gr.  viij ;  with  gr.  v.  of  Pulv.  Rhaei.  One 
dose  of  these  she  took  on  the  morning  of  the  16th,  but  failing  to  operate  by  the  evening,  it 
was  then  repeated:  this  also  producing  no  effect,  on  the  following  morning  half  an  ounce 
of  black  draught  was  quickly  succeeded,  as  before,  by  seven  or  eight  evacuations  of  a  foul 
and  offensive  character.  The  slight  indolence  of  the  bowels  just  mentioned  disconcerted 
her  not  a  little  throughout  the  16th,  and  then  excessive  action  next  day,  conjoined  with  this 
disturbance  of  mind,  manifestly  depressed,  still  further,  her  reduced  strength.  The  nervous 
symptoms  previously  marked  were  also  aggravated.  These  were,  deficiency  of  memory, 
great  anxiety,  and  timidity  regarding  her  own  state  of  health,  though  not  expressed  at  the 
time,  yet  plainly  indicated  by  countenance,  manner,  and  watchfulness,  but  not  what  could 
be  called  restlessness,  nor  was  there  any  complaint  of  want  of  sleep ;  she  expressed  herself 
rationally. 

January  18th. — The  nervous  irritation  was  unrelieved,  as  likewise  the  concomitant  febrile 
excitement.  The  bowels  had  been  freely  acted  upon  by  saline  aperient  medicines,  but  dur- 
ing the  day  she  made  complaint  of  pain  and  sense  of  obstruction  at  the  lowest  part  of  the 
sacrum,  accompanied  by  endeavors  at  expulsion,  as  if  there  was  some  lodgment  in  the  rec- 
tum. An  enema  of  plain  warm  water  was  used  in  the  evening,  and  some  softened  scybala 
passed  in  the  night  at  three  different  times.  She  was  much  alarmed  by  the  passage  of  these. 
But  the  enema,  when  repeated  on  the  following  morning,  brought  nothing  further  away,  save 
the  small  amount  of  mucus  adhering  to  the  bowels. 

About  the  middle  of  this  day  (the  19th)  she  felt  suddenly  more  faint,  and  twice  expressed 
the  fear  that  she  was  dying;  nervous  symptoms  much  the  same,  and  general  debility  such  as 
to  oblige  her  being  carried  out  of  and  into  bed,  during  the  few  minutes  occupied^in  making 
it  up.  For  the  last  two  days  she  was  unable  to  nurse  the  child,  not  unwillingly  on  her  part, 
as  the  exertion  was  too  great  for  her,  and  the  breasts  had  become  more  and  more  empty. 
Indeed,  for  these  reasons,  the  child  had  been  gradually,  and  by  longer  intervals,  kept  from 
the  mother,  and,  being  healthy  and  thriving,  gave  rise  to  no  anxiety;  of  course,  the  breasts 
were  now  relieved  artificially  of  their  contents. 

Ordered  Magn.  Sulph.  ^i.  Liquor  Amm.  Acet.  ^iij.Sp.  JEtheris.  Nit.  Zi.  Mist.  Carnph.  ^vj. 
6tu-  horis.  Also  a  night  draught,  containing,  in  addition  to  the  above,  nve  grains  of  Dover's 
powder.  v  ^*n» 

This  latter  procured  an  excellent  night's  rest,  and  in  the  morning  (20th)  the  pulse  had 
fallen  from  110,  and  upwards,  the  day  previous,  to  84,  was  soft  and  compressible,  and  con- 
tinued so  throughout  the  day.  She  complained  of  nausea  and  headache,  and  refused  her 
morning  tea,  but  the  manner  was  nearly  natural  again,  and  she  spoke  of  herself  as  much 
better  than  she  ever  expected  to  be;  the  bowels  were  freely  moved,  but  the  secretions  too 
dark  and  offensive ;  nourishment  was  obviously  required,  and  towards  the  latter  part  of  the 
day  more  was  taken  than  for  several  preceding  days,  in  the  shape  of  arrow-root  and  gruel, 
in  the  last  of  which,  she  had,  at  two  different  times,  altogether  nearly  t^fs.  of  brandy.  Not- 
withstanding this,  there  existed  much  confused  sensation  in  the  head,  the  sequel  of  the  morn- 
ing headache,  not  severe,  and  nausea,  resulting,  in  her  opinion,  from  the  anodyne ;  the  latter, 
of  which  she  expressed  a  great  horror,  was  not  repeated  at  night,  as  she  felt  inclination  to 
sleep,  and  did  sleep  naturally  from  eleven  to  three. 

21st. — At  the  last-mentioned  hour  she  awoke  with  intense  pain  in  her  head,  but  did  not 
send  for  her  husband  till  seven  o'clock.  He  found  her  more  excited  than  ever,  and  most 
apprehensive  about  herself;  the  pulse  was  again  above  120,  but  not  hard  or  full,  though 
certainly  approximating  to  these  characteristics  for  the  first  time ;  tongue  as  before ;  thirst 
rather  urgent;  considerable  heat  of  skin;  general  expression  of  countenance  anxious,  espe- 
cially indicated  by  the  eye.  Supposing  the  present  pain  to  be  still  referable  to  the  opiate, 
and  the  bowels  not  being  so  fully  opened  during  the  last  twelve  hours,  the  saline  draughts 
were  repeated  more  frequently,  and  front  part  of  the  head  covered  with  rags  wetted  in  cold 
vinegar  and  water.  The  secretion  of  milk,  though  slowly  diminished,  was  still  going  on  in 
the  breasts,  which  were  regularly  drawn,  and  there  was  no  cessation  of  the  trifling  and  natu- 
ral lochial  discharge.  The  milk  had  lost  its  sweetness,  and  was  more  pale  than  natural. 

A  drowsiness,  manifestly  increasing,  was  noticed  in  the  afternoon,  and  she,  when  interro- 
gated, stated  that  she  had  less  pain.  Deafness  came  on  rapidly  in  the  evening  about  six 
o'clock,  and  by  this  time,  unless  aroused,  she  seemed  wholly  unconscious  and  unobservant 
of  external  matters.  The  aspect  of  the  eyes  still  betrayed  anxiety,  and  a  stare  was  now 
perceptible;  the  irides  were  naturally  contracted,  and  there  was  no  increase  of  conjunctival 
vascularity.  The  head  was  hot,  and  the  carotids  beat  forcibly.  Her  position  in  bed  was 
easy,  and  on  the  side.  Pulse  at  130,  rather  thrilling,  very  regular  respirations,  40  in  the 


INFLAMMATION    OF    THE    HEMISPHERICAL    GANGLION.  331 

minute,  somewhat  nasal,  with  the  alse  nasi  contracted  and  visibly  in  motion;  tongue,  hereto' 
lure  rnoist,  had  a  tendency  to  dryness,  and  to  assume  a  brown  color.  Bowels  had  been 
twice  acted  upon  during  the  day,  the  stools  the  saane  as  before,  and  after  each  she  said  she 
experienced  relief  in  the  head.  The  urine  had  not  for  the  last  twenty-four  hours  been  so 
plentiful  as  of  late,  and,  in  fact,  might  be  pronounced  scanty ;  about  five  ounces,  perhaps,  in 
this  period. 

A  large  blister  was  applied  over  the  entire  cervical  spine  at  seven  o'clock,  when  she  had 
become  flushed,  and  more  heated,  and  more  thirsty.  Two  grains  of  calomel,  with  three  of 
Jarnes  s  powder,  were  administered.  The  latter  was  directed  to  be  repeated  every  three 
hours,  along  with  the  saline  draughts  and  ^fs.  of  Mist.  Sennae  two  hours  after  the  calomel; 
at  nine  there  were  noticed  slight  catchings  of  the  hand  and  forearm,  and  also  twitchings 
about  the  mouth.  Six  leeches  were  immediately  put  on  one  temple,  and  obtained  the  de- 
sirable quantity  of  blood ;  the  blister  was  rising  well ;  deafness  was  more  marked,  and  the 
drowsiness  augmented;  but  consciousness,  when  she  was  roused  and  spoken  to,  was  appa- 
rently unaltered,  though  her  natural  quickness  of  manner  was  lost,  and  had  been  going 
probably  for  the  last  six  hours.  On  the  side  of  the  head,  opposite  to  that  on  which  she  was 
lying,  a  small  blister  was  placed  behind  the  ear,  and  upon  the  temple;  about  twelve  o'clock, 
she  took  diluents  and  the  medicines  readily  from  her  husband,  whose  voice  alone  she  recog- 
nized, but  refused  them  from  others. 

Up  to  this  period  the  patient  had  been  under  the  care  of  her  husband  and  his  partner. 

At  4  A.M.  of  the  22d,  the  exhibition  of  mercury  was  advised  by  Mr.  Wickham,  of  Win- 
chester, and  calomel  was  given  in  two-grain  doses  every  two  hours ;  the  head  was  shaved, 
and  slightly  enveloped  in  cloths  wrung  out  of  iced  water.  The  condition  of  the  eye  was 
then  unchanged,  but  all  the  former  symptoms  were  continuing,  and.  if  possible,  aggravated, 
excepting  the  subsultus,  which  was  visibly  abated:  congestion  of  blood  in  the  brain  was 
considered  to  exist  by  Mr.  Wickham  and  the  other  surgeons.  They  agreed  as  to  the  danger 
to  be  apprehended  from  effusion  on  the  one  hand,  and,  on  the  other,  from  depression  of  the 
vital  powers  (never  other  than  feeble  in  this  patient,  as  before  stated)  by  mercury,  and  the 
other  remedies  necessary.  Had  she  not  been  in  this  doubtful  state,  Mr.  W.  thought  the 
pulse  would  have  justified  further  abstraction  of  blood,  even  from  the  arm.  This,  however, 
he  could  not  recommend,  but  he  would  not  hesitate  to  resort  to  leeches  again,  if.  the  power 
of  the  pulse  continued  much  longer  unabated.  It  should  have  been  mentioned,  that  by  the 
hour  of  his  visit  the  pulse  had  acquired  a  hardness,  and  increased  thrilling.  In  the  supply 
of  nourishment,  the  greatest  caution  was  hereafter  requisite.  The  strength  was  to  be  sup- 
ported by  beef  tea,  and  arrow-root,  and  other  farinaceous  substances,  in  quantities  to  be  regu- 
lated by  the  pulse,  heat  of  skin,  and  degree  of  cerebral  symptoms.  Dry  warmth  was  applied 
to  the  breasts,  which  had  been  drawn  twice  in  the  previous  six  hours,  and  yielded  each 
time  upwards  half  an  ounce  of  milk.  At  8  o'clock  A.M.,  the  flushing  has  subsided  simultaneously 
with  diminution  of  carotid  action  and  the  absence  of  pain,  and  the  whole  face  became 
pinched  and  shrunk,  and  deathly  pallid;  the  tongue  had  not  become  dry;  pulse  and  respira- 
tion the  same  in  frequency;  the  former  less  thrilling,  and  the  latter  remarkably  gentle  and 
not  so  nasal.  All  three  blisters  had  risen,  and  discharged  copiously.  In  this  state  of  appa- 
rent depression  she  continued  for  the  next  twelve  hours,  with  the  alteration  of  a  flush, 
lasting  about  two  hours ;  between  two  and  four  o'clock  equally  conscious,  though  inca- 
pable of  returning  answers  quite  coherent,  when  excited  to  take  food  or  medicine,  and  as 
easily  aroused  for  this  purpose.  But,  these  times  excepted,  she  lay  throughout  the  whole 
day  on  her  side  as  before,  utterly  indifferent  to  all  things  and  persons  around  her,  with  the 
eyes  constantly  closed  as  if  in  the  softest  sleep,  whilst  this  state  of  heavy  drowsiness  re- 
curred directly  after  she  had  swallowed  either  food  or  medicine.  These  she  still  took  most 
readily  from  her  husband,  and  in  quite  sufficient  abundance.  Several  copious  evacuations 
had  passed  involuntarily  from  the  bowels,  of  the  former  appearance ;  and  urine  also  more 
freely  in  the  same  way.  An  evaporating  lotion,  composed  of  spirit  and  muriate  of  ammo- 
nia, was  substituted  for  the  iced  water,  and  compound  spirit  of  aether  was  dropped  upon  the 
scalp  at  short  intervals,  the  heat  of  head  being  undiminished,  as  also  the  excessive  carotid 
impulsion.  A  second  large  blister  was  applied  over  the  upper  site  of  the  former,  at  the 
nape  of  the  neck,  at  six  o'clock,  and  the  former  remedies  had  been  regularly  exhibited. 

23d,  8  A.  M. — About  ten  o'clock  last  night  her  husband  had  great  difficulty  in  rousing  her 
to  take  sustenance,  on  two  separate  occasions,  arid  at  intervals  of  only  a  few  minutes ;  and 
when  she  temporarily  awoke  out  of  this  stupor,  or  extreme  somnolence,  the  stare  was  more 
strongly  visible,  though  the  pupils  were  naturally  susceptible  of  contraction,  and  the  eyes 
indicated  no  other  morbid  or  unnatural  expression.  Pulse  between  120  and  130,  less  pow- 
erful, but  not  soft;  respiration  36;  flapping  of  both  cheeks  during  each  expiration,  attended 
by  an  audible  purring  sound ;  this  peculiar  state  of  breathing  lasted  not  above  a  quarter  of 
an  hour.  Considerable  flushing  of  the  face  succeeded  to  this,  with  increase  of  general  heat, 
and  force  of  pulse,  as  well  as  rapidity.  Two  grains  of  ammonia  had  been  given  twice, 


332  HUMAN    BRAIN. 

nearly  an  hour  apart,  while  the  depression  attendant  on  that  special  state  of  respiration 
lasted.  The  blister  was  taken  off  at  twelve,  and  had  produced  a  good  quantity  of  serum. 
The  remedies  have  been  persisted  in,  with  the  cautious  supply  of  nutriment,  and  at  two 
o'clock  she  displayed  some  excitability.  She  moved  the  lower  extremities  about  in  bed,  and 
asked  questions  in  a  loud  tone,  but  incoherent  manner,  of  the  two  female  attendants  beside 
her.  Her  husband  at  once  stilled  her,  and  of  him  she  took  slight  notice,  and  began  to  make 
inquiries  in  a  mode  different  from  that  recently  shown.  Since  then  a  return  of  general 
sensibility  has  been  perceptible.  Pulse  now  120,  firm,  and  rather  hard  ;  respirations  reduced 
to  34,  and  quite  regular,  also  freer;  bad  been  now  and  then  slight  sighing,  and  stertor  ;  three 
dark  motions,  the  product  of  calomel,  have  been  voided  involuntarily,  with  a  good  deal  of 
flatus ;  urine  passes  also  unrestrained.  Nourishment  to  be  taken  less  liquid,  though  thirst  is 
urgent;  this  is  to  be  relieved  by  effervescing  draughts,  ad  libitum. 

8  P.M. — Through  the  kindness  of  Mr.  Solly,  who  accompanied  him,  Dr.  Cape  visited  the 
patient  about  six  o'clock.  In  addition  to  the  plan  we  were  pursuing,  he  prescribed  Camphor 
two  grains,  reduced  to  powder,  with  spirit  of  wine,  and  carefully  rubbed  down  with  muci- 
lage, so  as  to  be  suspended  in  the  fluid  form,  with  eighteen  minims  of  tinct.  Hyoscyami, 
every  three  hours.  The  margin  of  the  lower  gums  evinced  slight  redness,  although  the 
calomel  affected  the  bowels  a  good  deal.  During  the  day  the  pulse  had  fallen  to  1 10,  but 
had  lost  little  of  its  power,  and  the  respiration  was  now  at  30.  On  first  seeing  her,  Dr. 
Cape  found  the  pulse  at  120,  but  on  re-entering  her  room  about  an  hour  afterwards,  it  did 
riot  exceed  108.  There  was  exhibited  on  the  tongue,  still  moist,  a  trifling  copper  colored 
fur,  attributed  to  the  local  as  well  as  a  general  action  of  the  calomel.  Soothing  and  cheering 
words  have  visibly  had  an  excellent  effect  upon  her  the  last  four  hours,  and  the  comfort  and 
consolation  Dr.  Cape  afforded  her,  by  confidently  assuring  her  of  recovery,  were  evidently 
particularly  exhilarating.  The  disposition  to  sleep  was  yet  strong,  and  as  there  were  no 
longer  the  same  heaviness  and  hebetude  in  its  character,  now  nearly  natural,  it  was  evi- 
dently refreshing,  and,  when  asked,  pronounced  it  such  herself.  Of  course  the  strictest  qui- 
etude has  been  observed  throughout,  and  was  now  more  requisite  than  ever.  In  the  morning 
she  had  complained  of  shortness  of  breath,  but  there  was  no  dyspnoea  observable,  and  the 
feeling  passed  off  after  two  small  doses  of  ammon.  carbon.  The  nutriment  was  as  dry  and 
astringent  as  she  could  take,  namely,  beef  tea  thickened  with  isinglass,  arrow-root  and 
biscuit  boiled  into  jelly.  She  now  requested  frequently  to  have  her  thirst  satiated  by  the 
effervescing  medicines. 

24th,  8  A.  M. — The  calomel  has  been  latterly  given  every  three  hours,  as  its  general  lower- 
ing influence  was  manifested  in  the  system,  and  the  local  action  on  the  gums  was  com- 
mencing. Pulse  about  108,  or  rather  below  this  number,  softer,  and  less  resisting;  respira- 
tions 26  and  24  ;  more  free,  and  natural ;  surface  of  the  body  and  limbs  warm,  the  heat 
having  diminished;  bowels  acting  freely,  the  dejections  dark,  and  containing  mucus; 
passed  but  little  urine,  though  feeling  desire  to  do  so :  has  been  conscious  when  evacuating. 
The  restoration  of  consciousness  and  general  sensibility  is  still  more  perceptible,  together 
with  more  normal  voice  and  manner.  She  says  her  head  feels  dizzy,  and  acknowledges 
some  pain  about  the  forehead  and  occiput,  and  also  that  from  the  blistered  surfaces.  Shows 
aversion  to  light,  but  no  intolerance  of  sound  ;  expresses  comfort  from  the  ether  and  cold 
applications  to  the  scalp,  and  begs  often  for  them  to  be  re-applied ;  calls  likewise  for  the 
effervescing  draughts  to  allay  the  great  thirst,  another  subject  of  complaint  now  made  by  her. 

8  P.  M. — Symptoms  have  continued  improving ;  in  addition  to  the  matters  complained  of 
by  her  this  morning,  she  feels  the  griping  of  the  bowels,  and  lays  it  to  the  effervescing  (or 
"  lemon")  draughts,  of  which  she  objects  to  take  more.  She  being  unable  to  void  urine,  after 
frequent  and  anxious  attempts,  about  a  pint  was  removed  by  the  catheter,  clear  and  healthy, 
at  one  o'clock.  Pulse  averaging  from  98  to  108,  much  softer,  and  diminished  ;  breathing 
nearly  natural ;  has  enjoyed  much  calm  and  quiet  sleep,  to  which  there  is  a  great  readiness, 
but  not  the  previous  constant  strong  inclination.  Our  former  remedies  have  been  persevered 
in  as  yesterday,  except  the  effervescing  draughts ;  and  the  beef-tea,  arrow-root,  &c.,  have 
been  daily  taken. 

25th,  8  A.M. — Since  12  last  night,  the  calomel  has  been  given  in  one-grain  doses  every 
three  hours,  as  by  that  hour  the  gums  were  whitened,  and,  in  the  judgment  of  Mr.  Solly, 
and  her  husband,  the  force  of  the  circulation  was  materially  arrested.  She  is  still  very 
sleepy ;  skin  moist,  and  breathing  natural ;  bowels  moved  freely  in  the  last  24  hours,  and 
evacuations,  as  was  to  be  expected,  the  same.  No  urine  has  been  discharged,  but  the  blad- 
der is  not  distended,  nor  uncomfortable;  some  tenderness,  however,  on  pressure  over  it. 
Pulse  98,  during  sleeping;  open  and  soft;  when  she  is  roused,  about  108  ;  tongue  moist,  and 
inclining  to  whiteness;  the  flushings  have  recurred  occasionally,  but  more  slightly;  heat  of 
iiead  externally  not  diminished,  and  the  ether  and  evaporating  lotion  are  equally  grateful: 
the  thirst  has  been  less  urgent,  and  the  saline  draughts,  therefore,  unnecessary ;  otherwise, 
the  diet  and  medicines  have  been  the  same. 


INFLAMMATION   OF   THE    HEMISPHERICAL   GANGLION.  333 

8  p.  M. — She  hag  had  no  calomel  since  nine  this  morning,  as  its  effects  have  become  more 
apparent  in  the  mouth,  and  the  odor  of  the  breath.  The  bowels,  too,  are  a  good  deal  irritated, 
but  there  is  not  much  complaining  from  this  cause  ;  feels  her  head  dizzy,  and  occasional 
trifling  pain  therein.  Pulse  98,  soft  but  not  flagging;  skin  comfortable  ;  the  camphor  and 
hyoscyamus  have  been  taken,  but  no  other  medicines;  rather  more  than  a  pint  of  urine  was 
drawn  off  again  at  two  p.  M.,  previously  to  which  she  had  expressed  considerable  uneasi- 
ness. 

26th.  8  A.  M. — It  was  necessary  to  draw  off  the  urine  again  this  morning,  at  two  o'clock, 
in  consequence  of  the  patient  having  made  painful  efforts  of  expulsion — there  was  about  a 
pint,  and  equally  clear ;  motions  from  the  bowels  continue  of  the  same  nature,  and  very 
copious  and  watery;  she  is  generally  conscious  when  passing  them.  Pulse  96,  unaltered  in 
character;  soreness  of  the  mouth  complained  of;  tongue  white,  and  more  furred,  and  the 
gums  more  affected ;  sleepiness  undiminished,  but  sensibility  and  sensation  obviously  increas- 
ing. There  has  been  no  further  occasion  for  calomel ;  the  camphor,  &c.,  has  been  regularly 
exhibited,  and  the  saline  draught  once  or  twice. 

8  P.  M. — There  has  been  less  disposition  to  sleep,  and  a  very  perceptible  acquisition  of 
sensibility  and  memory.  The  bowels  have  not  been  so  much  acted  upon,  and  she  has  voided 
urine  by  her  own  endeavors.  Pulse,  during  present  sleep,  90.  By  her  own  desire,  she  has 
partaken  of  more  nourishment  during  the  day,  and  has  shown  improved  strength ;  one  large 
watery  stool  was  discharged  this  afternoon  involuntarily. 

27th. — Was  permitted  to  sleep  for  five  hours  together  last  night,  as  she  rested  so  tran- 
quilly and  naturally ;  there  has  been  considerably  less  flushing.  Pulse  90,  not  weak ;  but 
soft,  and  with  nearly  a  natural  stroke.  The  faeces  and  secretions  of  urine  have  been  passed 
consciously,  an  d  the  former,  more  sparingly  and  fewer,  changing  gradually  to  a  lighter  green, 
are  now  yellow.  Has  eaten  a  little  sopped  bread  at  her  own  request,  and  could  have  taken 
more  but  from  the  increasing  soreness  of  her  mouth;  on  this  latter  account,  she  finds  the 
effervescing  medicine  again  agreeable ;  the  camphor  and  hyoscyamus  are  continued  every 
four  hours,  with  the  former  allowance  of  beef-tea,  jelly,  arrow-root,  &c.  In  proof  of  return- 
ing sensibility,  it  may  be  mentioned,  that  she,  this  morning,  sent  her  nurse  up  into  the  nursery 
to  bring  her  word  how  the  children  were,  and  made  many  inquiries,  and  gave  directions 
then  in  her  usual  manner,  as  well  as  respecting  some  other  affairs  ;  and,  in  proof  of  strength, 
also,  being  gained,  when  it  was  necessary,  last  night,  to  arrange  her  bed,  she  experienced  far 
less  fatigue  from  being  moved  than  on  the  day  only  previous. 

28th. — The  strong  disposition  to  sleep  is  wearing  off,  though  she  continues  perfectly  quiet ; 
says  she  can  hear  better,  and  shows  some  slight  intolerance  of  sound,  but  has  sensibility 
to  light.  The  wet  cloths  are  also  uncomfortably  cold,  and  the  heat  of  head  not  now 
being  greater  than  natural,  they  are  omitted.  Pulse  80,  during  sleep,  90  when  awake,  quite 
natural;  bowels  still  relaxed,  but  the  faeces  natural;  passes  urine  by  herself,  and  in  plenty ; 
there  is  slight  vertigo,  together  with  occasional  uneasiness,  referred  to  the  head ;  but  she  may 
be  now  pronounced  perfectly  conscious,  and  free  from  the  least  aberration  of  mind,  though 
the  power  of  recollection  is  very  feeble.  She  displays  some  anxiety  concerning  the  future 
management  of  the  child,  but  this  has  been  apparently  allayed.  Camphor,  &c.,  to  be  taken 
at  intervals  of  six  hours,  and  the  diet  more  astringent;  mouth  and  gums  relieved  by  gargling 
with  the  chlorides  in  barley  water. 

29th. — Has  had  less  sleep,  both  by  night  and  by  day;  pulse  and  other  symptoms  as  yester- 
day. Chief  complaint  made  of  the  mouth,  which  looks  well;  bowels  restrained,  and  voids 
her  urine  without  difficulty.  Both  takes  and  has  desire  for  more  nourishment.  Continue  as 
yesterday.  Hydr.  c.  Greta  gr.  iii.  Pulv.  Rhaei.  gr.  v.  P.  Pulv.  hac  nocte  sumend. 

39. — Some  nausea  and  pain  were  produced  by  the  powder,  but  subsided  as  soon  as  the 
bowels,  which  have  not  acted  for  36  hours,  were  moved  by  it.  Has  had  four  stools,  relaxed 
and  quite  healthy.  Pulse  as  yesterday  ;  there  has  been  scarcely  any  sleep  in  the  night,  from 
the  disturbance  just  mentioned,  but  is  now  sleeping  tranquilly ;  gums  and  mouth  rather  better, 
and  she  feels  appetite. 

This  patient  perfectly  recovered,  and  is  now.  well  and  hearty  too,  1846. 

Early  in  the  year  1845,  when  the  railway  mania  was  at  its  height,  I 
was  requested  to  visit  a  gentleman  at  an  hotel  in  the  City,  who  was 
quite  insane.  When  I  entered  the  room  he  immediately  ordered,  in  a 
loud  authoritative  tone,  his  attendant  to  leave  the  room.  He  looked  at 
me  to  know  if  he  was  to  do  so,  and  as  I  was  quite  sure  that  I  should  be 
of  little  service  if  I  did  not  obtain  the  confidence  of  my  patient,  I  im- 
mediately assented.  My  patient,  who  was  a  fine  tall  muscular  man, 
was  lying  on  the  sofa  ;  he  now  rose  and  asked  me  what  I  wanted.  I  told 


334  HUMAN   BRAIN. 

him  that  I  came  to  prescribe  for  him,  as  I  understood  that  he  was  not 
well.  He  then  asked  me  if  I  was  a  physician  or  a  surgeon.  On  rny 
informing  him  that  I  was  the  latter,  he  said,  "Very  well,  that  will  do  ; 
they  are  not  humbugs  generally."  He  then  said,  uBut  I  want  no  medi- 
cal advice;  I  never  was  better  in  my  life,"  and  began  talking  incessant- 
ly, telling  me  he  had  made  an  enormous  fortune  in  railways,  and  how 
the  Almighty  had  enabled  him  to  do  so.  His  conversation  was  rambling, 
incorrect,  and  founded  on  the  most  absurd  delusions.  His  head  was 
hot,  and  his  face  flushed,  and  he  had  had  no  sleep  for  several  nights. 
I  learned  that  he  had  first  shown  decided  mental  derangement  only  a 
few  days  previous  to  ray  visit.  Morphia  had  been  administered  in  large 
doses,  but  without  the  slightest  effect.  He  was  always  worse  at  night. 
I  ordered  forty  leeches  to  the  forehead,  fomentations  to  promote  bleed- 
ing, and  afterwards  cold  lotions ;  five  grains  of  calomel  with  rhubarb 
and  jalep,  and  a  second  draught  in  the  morning.  I  found  him  more 
tranquil  the  next  day,  having  had  about  an  hour's  sleep.  I  repeated 
the  leeches  and  the  calomel.  On  the  third  day  he  was  so  rational  and 
quiet  that  he  accompanied  me  in  my  own  carriage,  the  attendant  riding 
on  the  box,  to  a  cottage  in  the  neighborhood  of  the  Regent's  Park. 
Here  I  pursued  the  same  plan  of  treatment,  leeching  the  head  freely,  but 
always  first  persuading  him  that  they  were  necessary  for  his  recovery. 
Each  night  he  got  a  little  more  sleep,  though  it  was  slow  in  returning. 
About  the  fifth  night  he  slept  quite  naturally,  and  without  a  grain  of 
opium  in  any  form.  I  gave  two  grains  of  gray  powder,  with  a  grain  of 
aconite,  three  times  a  day.  He  took  a  great  deal  of  exercise,  and  re- 
covered perfectly  in  a  fortnight  from  the  date  of  my  first  visit. 

If  a  different  course  of  treatment  had  been  pursued  in  the  case,  I 
have  very  little  doubt  he  would  have  been  rendered  a  confirmed  lunatic. 
If,  for  instance,  the  strait  waistcoat  had  been  applied  at  night  when 
he  was  noisy  and  riotous,  instead  of  being  soothed  and  talked  to  kindly, 
or  if  he  had  been  confined  in  one  of  the  old-fashioned  insane  establish- 
ments with  barred  windows  and  bolted  doors,  the  disease  would  have 
been  confirmed,  and  the  brain  most  probably  irremediably  injured. 
Harsh  treatment  to  a  lunatic  produces  as  much  mischief  to  his  inflamed 
brain  as  the  jolting  of  a  wagon  without  springs  would  to  a  compound 
fracture  of  the  leg. 

I  have  had  three  very  similar  cases,  all  of  which  recovered  under  the 
same  general  plan  of  treatment. 

The  following,  from  Andral,  is  a  good  case  in  illustration  of  the  fact 
that  the  cerebral  circulation  may  be  suddenly  excited  by  an  impression 
from  moral  causes  carried  centripetally. 

Case  35. — Jlpoplexy  with  Hemiplegia  in  consequence  affright. — A  robust,  and  rather  plethoric 
woman,  thirty-eight  years  old,  was  in  perfect  health,  and  speaking  to  a  neighbor,  when  her 
servant  girl  frightened  her  by  brandishing  a  bright  spiral  wire  over  her  head,  so  as  to  make 
it  look  as  if  a  snake  were  falling  on  her.  In  her  fright,  the  woman  suddenly  fell  down  as  in  an 
apoplectic  fit,  and  remained  for  some  time  nearly  unconscious.  When  examined,  she  com- 
plained of  a  noise  and  beating  in  the  left  side  of  her  head,  deafness  of  the  left  ear,  and  of 
blindness  and  loss  of  taste  on  the  same  side.  She  could  not  move  any  part  of  the  left  side 
of  the  body,  and  in  every  respect  resembled  a  patient  suffering  from  hemiplegia,  in  conse- 
quence of  sanguineous  apoplexy.  By  active  antiphlogistic  treatment,  and  various  other 
measures,  she  was  gradually  restored  from  this  state  in  about  three  months. 


INFLAMMATION   OF   THE   HEMISPHERICAL    GANGLION.  335 

Worry  in  business,  mental  anxiety,  and  vexation  of  spirit,  will  some- 
times bring  on  spasmodic  action  of  the  muscles,  and  paralysis.  In  some 
cases  the  anxiety  and  mental  irritation  induce  disease  in  the  hemispheri- 
cal ganglion,  seriously  affecting  the  temper,  but  not  affecting  the  intellect. 
Such  cases  are  familiar  to  all  practical  men,  but  it  is  very  difficult  to 
explain  their  pathology.  I  suppose  that  the  disease  or  diseased  action 
excites  unnaturally  the  tubular  neurine,  which,  commencing  in  this  gan- 
glion as  the  motor  tract,  conducts  the  will  to  the  muscles;  and  the  con- 
sequence of  this  excitement  is  an  irregular  supply  of  stimulus  to  the 
muscular  system  exhibited  by  the  twitchings  and  spasms.  This  irregular 
action  the  mind  can  more  or  less  control  and  arrest  when  awake;  but  as 
soon  as  sleep  takes  place,  then  the  spasms  commence.  I  suspect  that 
epilepsy  is  a  form  of  this  irregular  innervration,  only  that  in  epilepsy 
the  nervous  or  electric  fluid  accumulates  in  undue  quantity?  and  passes 
off  in  a  large  quantity  at  once,  like  the  discharge  of  an  electric  battery. 
In  many  cases  of  epilepsy,  the  discharge  takes  place  in  small  quantities 
both  before  and  after  the  complete  fit.  I  have  two  patients"  under  my 
care  now  who  suffer  seriously  in  this  way  :  one,  a  single  man,  has  always 
warning  of  the  advent  of  the  fit  by  twitchings  of  the  right  leg  as  soon 
as  he  drops  off  to  sleep  ;  the  other,  a  married  man,  has  these  twitchings 
so  constantly  in  bed,  that  his  wife  is  often  kept  awake  during  a  whole 
night.  In  the  non-epileptic  cases,  though  electric  fluid  is  secreted  in 
undue  quantities,  still  it  does  not  accumulate,  so  as  to  produce  a  com- 
plete convulsive  fit,  but  is  constantly  oozing  out.  Whether  this  idea  is 
correct  or  not,  it  is  difficult  to  say;  but  the  following  case  will,  I  think, 
show  that  it  is  of  value: — 

Case  36. — A  medical  man,  aged  40,  nerve-sanguineous  temperament,  who  had  been  en- 
gaged in  practice  for  some  years  in  the  North  of  England,  consulted  me  in  the  spring  of 
1842  with  the  following  symptoms: — Some  numbness  down  the  right  leg  and  arm,  dragging 
of  both  lower  extremities,  but  especially  the  right.  This  partial  paralysis  was  so  severe, 
that  it  was  with  difficulty  he  walked  a  mile;  on  going  to  sleep,  his  limbs  started  so  violently 
as  to  wake  him.  He  gave  me  the  following  account  of  himself.  General  health  in  every 
respect  was  quite  good  until  four  months  ago ;  when  one  night,  on  dropping  off  to  sleep,  a 
sudden  catching  up  of  the  thighs  came  on;  soon  after  this  the  starting  affected  the  whole 
limb.  This  condition  came  on  four  or  six  times  every  night  before  going  to  sleep.  There 
was  also  numbness  of  the  right  thigh  and  pain  in  the  course  of  the  sciatic  nerve,  odd  erratic 
thrills  of  pain  in  the  muscles  of  the  same  side  and  head.  No  convulsive  action  of  the  upper 
extremity  at  any  time.  Walking  soon  fatigued  the  right  leg.  On  napping  after  dinner,  these 
startings  always  came  on,  so  that  he  often  stood  up  to  be  free  from  desire  to  sleep. 

Stomach  and  bowels  in  good  condition.  He  went  to  the  sea-side  about  six  months  after 
the  appearance  of  these  symptoms,  and  by  the  advice  of  an  eminent  physician  and  surgeon, 
took  Pil.  Hyd.  gr.  v.  t.  d.,  and  applied  blisters  to  the  spine,  and  a  seton  in  the  neck,  which 
remained  two  years.  He  was  much  relieved  from  the  catchings,  but  reduced  by  the 
treatment.  During  the  summer  the  lowering  effects  of  mercury  were  overcome,  and  he 
attended  lightly  to  practice,  but  in  the  autumn  the  symptoms  were  renewed.  He  says,  "  I 
dragged  on  through  the  winter  with  feeble  power,  irregular  muscular  convulsions,  and  pain 
in  the  course  of  the  sciatic  nerve."  Early  in  the  spring  his  medical  friends  urged  his  giving 
up  practice  ibr  a  year  or  two.  Up  to  this  time  his  complaint  had  been  considered  spinal, 
and  the  counsel  he  received  was  often  contradictory  5  one  very  eminent  surgeon  recom- 
mended tonics  and  to  live  well ;  another  considered  it  spinal  irritation  reflected  from  the 
digestive  organs. 

After  conversing  with  him  for  some  time,  and  knowing  previously  a  good  deal  of  his 
mental  and  moral  qualities  and  excitable  temperament,  observing  the  way  in  which  he  was 
constantly  putting  his  hand  to  his  head,  impelled  by  a  feeling  of  uneasiness  there  rather  than 
severe  pain,  1  felt  convinced  that  the  affection  was  cerebral,  and  not  spinal. 

In  a  consultation  whi  h  I  had  with  two  of  those  medical  friends  under  whom  he  had 
been  before  seeing  me,  J  urged  my  reasons  for  so  thinking,  and  they  acquiesced  in  my  view 
of  it.  Previously  they  had  recommended  a  voyage  to  India  as  surgeon  to  the  vessel ;  this 


336  HUMAN    BRAIN. 

was  with  the  view  of  saving  unnecessary  expense.  On  this  I  remarked  that  if  he  did  so, 
the  sailors  would  drive  him  mad.  I  urged,  that  the  only  chance  of  saving  him  from  actual 
mental  derangement  was  entire  rest  of  mind  and  abstinence  from  bodily  fatigue. 

The  observation  that  I  made  with  regard  to  the  sailors,  of  course,  was  not  repeated  to 
him ;  it  was,  therefore,  curious  that  in  one  of  his  letters,  written  during  the  course  of  the 
next  summer  from  Jersey,  he  should  have  said — "  I  have  often  felt  the  wisdom  of  your 
urging  me  not  to  take  the  voyage  to  India;  the  worry  of  the  crew  would  have  bothered  me 
to  death." 

Without  going  through  all  the  details  of  his  progress,  I  will  quote  a  few  passages  from 
his  letters  written  during  his  absence  from  home.  Italics  my  own. 

June  3d,  1842. — "During  the  month  I  have  been  from  home  I  have  experienced  little,  if 
any,  mitigation  of  the  convulsive  catchings  which  come  on  as  I  am  passing  into  sleep.  The 
uneasiness  of  the  head  remains  the  same,  and  the  sense  of  heaviness  or  confusion  under 
much  fatigue  or  excitement.  The  kg  is  much  better,  and  were  it  not  soon  fatigued  by  mus- 
cular exertion,  I  think  I  could  walk  as  well  as  ever.  My  spirits  are  generally  good,  and  my 
general  health  may  be  called  excellent.  I  continue  the  gr.  ij.  of  blue  pill  every  night, 
which  you  will  remember  I  recommenced  at  your  suggestion  near  three  months  ago.  I 
keep  the  head  shaved,  and  commonly  sit  without  my  wig." 

July  4th,  1842. — "I  certainly  am  not  worse  than  when  I  wrote  a  month  ago ;  I  have  con- 
tinued the  blue  pill  till  the  last  few  days;  I  now  substitute  the  sarsaparilla  with  liq.  hyd. 
bichlorid.  The  gums  have  been  slightly  tender ;  I  have  felt  very  feeble,  and  since  your  last 
favor  have  most  carefully  avoided  fatigue  ;  I  rarely  get  up  till  twelve  or  one  o'clock.  The 
iodine  has  been  painted  over  the  whole  of  the  shaved  scalp  even  to  your  heart's  content ;  and 
much  smarting  every  other  night  and  a  plentiful  exfoliation  of  cuticle  does  it  keep  up.  I 
have  little  other  pain;  the  right  leg  gets  numb  now  and  then,  and  would,  I  dare  say,  if  I 
tried  to  walk  much,  soon  tire.  Writing  gives  me  some  uneasiness  of  head,  &c.  The  '  catch- 
ings  and  jerkings'  of  the  body  come  on  every  night  on  my  going  off  to  sleep.  This  condition 
abiding,  I  must  deem  myself  about  in  statu  quo,  though  the  quietude  I  cultivate  and  the  dis- 
cipline I  undergo,  through  your  most  judicious  advice,  must  be  favorable  for  damaged  structure 
to  recover  its  original  condition.1' 

August  1st,  1 842. — "  When  I  was  in  Dublin  I  was  induced  to  see  Graves.  He  said  I 
should  not  continue  longer  the  mercury,  that  it  had  done  its  work  right  enough ;  that  if  I 
was  to  be  opened  at  once,  no  disease  would  be  discovered ;  he  supposed  chronic  arachnitis 
had  existed,  &c. ;  bade  me  take  Argent.  Nit.  gr.  £  t  d.,  avoid  wine  and  eggs,  take  a  tepid 
shower  bath  daily,  and  continue  the  seton. 

"I  have  the  last  few  days  suspended  the  bichloride  of  mercury;  I  have  had  four  months 
of  it  and  blue  pill,  but  I  have  not  taken  the  nitrate  of  silver.  Graves  says  you  know  it  is 
a  tonic  which  does  not  determine  to  the  head.  What  say  you  "?" 

I  wrote  to  hirn  saying  that  I  had  no  objection  to  the  Argent.  Nit.,  but  I  was  doubtful  of 
its  being  of  service. 

He  began  it,  and  continued  it  for  about  three  weeks,  but  it  did  not  seem  to  agree  so  well 
with  him  as  the  mercury. 

About  the  18th  of  August  I  wrote  to  him,  recommending  the  application  of  four  leeches 
every  night  for  a  week,  the  bleeding  encouraged  by  exhausted  glasses. 

One  or  two  moderate  doses  of  salts  in  the  morning. 

"Under  this  plan."  says  this  gentleman  in  a  letter  I  lately  received  from  him,  "the  head 
was  much  relieved  in  so  marked  a  degree  that  I  dated  recovery  from  this  period.  Leeches 
were  applied  over  and  over  again  at  intervals  for  many  weeks,  eight  or  ten  at  a  time.  It 
always  appeared  to  me  that  the  leeches  and  the  small  tloses  of  mercury  did  a  vast  deal  of 
good,  but  the  '  catchings'  were  not  cured  by  them. 

"  Through  the  autumn  and  winter  while  in  Spain  the  same  treatment  was  more  or  less 
adopted  (dry  cupping  often  over  the  scalp),  but  the  blue  pill  gr.  iij.  was  left  off;  resumed 
again  in  January  in  small  doses,  and  continued  ten  or  twelve  weeks. 

"I  returned  to  England  in  May,  1843,  in  every  way  very  much  improved — well — except 
the  occurrence  now  and  then  of  'catchings.'  The  last  three  years  I  have  been  in  general 
good  health;  but  have  the  jumpings  come  on  very  much  after  fatigue  or  worry,  or  tea  before 
going  to  bed.  Now,  October,  184(5,  I  feel  generally  as  well  as  ever;  have  been  so  for  the  past 
year;  and  during  the  last  month  have  often  walked  for  four,  six,  or  eight  hours  a  day,  with 
gun,  and  powder,  and  shot,  with  ease  and  enjoyment,  but  the  catchings  are  not  gone  clean 
away." 

Mr.  Dunn,  of  Norfolk  Street,  has  related  a  most  interesting  case  in 
the  twenty-fifth  volume  of  the  Med.-Chir.  Transactions,  which  corrobo- 
rates my  view  of  the  pathology  of  the  above  case.  Dr.  Dunn's  case  is 
well  worthy  of  perusal  in  full,  but  I  shall  only  refer  to  those  points  which 


INFLAMMATION    OF    THE    HEMISPHERICAL    GANGLION.  337 

bear  upon  the  present  division  of  our  subject.  The  patient  was  a  little 
boy  two  years  old,  a  fine,  intelligent  child  ;  the  first  indication  of  disease 
was  a  change  in  the  disposition  of  the  child.  From  being  a  happy,  pla- 
cid child,  he  had  become  irritable,  peevish,  and  petulant,  impatient  of 
control.  This  was  going  on  for  four  months  before  the  parents,  intelligent 
people,  considered  the  child  bodily  ill,  requiring  medical  advice.  Mr. 
Dunn  was  called  to  him  six  weeks  previous  to  death.  He  had  awoke 
as  usual,  between  six  and  seven  o'clock  in  the  morning,  and  his  mother 
was  alarmed  by  observing  his  left  hand  begin  suddenly  to  twitch  and 
jerk  convulsively.  The  intellectual  faculties  were  not  then  affected  ; 
the  child  was  laughing  and  talking,  and  perfectly  sensible.  The  child 
had  fallen  down  stairs  fourteen  days  previously  to  this  attack.  On  the 
third  day  from  first  occurrence  of  the  convulsive  action  of  the  arm,  Mr. 
D.  observed  an  imperfect  paralysis  of  the  hand  and  arm.  On  the  fourth 
day  the  convulsive  jerkings  were  not  confined  to  the  arm,  but  involved 
the  whole  of  the  left  side  and  lower  extremity,  with  twitchings  of  the 
eye  and  angle  of  the  mouth.  These  fits  increased  in  violence.  To- 
wards their  termination,  (and  they  lasted  about  two  hours,)  he  cried 
and  screamed  violently,  but  throughout  their  continuance  he  was  sensi- 
ble, and  could  at  times  be  soothed  by  kind  attentions  from  his  parents. 
The  fits  were  followed  by  profound  sleep  for  several  hours,  and  the  side 
was  left  partially  paralyzed.  The  paralysis  was  not  persistent.  A  few 
days  previous  to  his  death,  the  right  side  was  also  affected.  He  had 
these  convulsive  attacks,  with  slight  intermissions,  throughout  the  day 
before  he  died,  screaming  violently  at  intervals.  The  rest  is  given  in 
Mr.  Dunn's  own  words  : — 

"The  head  was  hot,  face  flushed,  pulse  hurried,  pupils  dilated,  eyes  squinting,  and  turned 
inwards,  insensible  to  light,  eyelids  constantly  open,  and  only  at  times  recognizing  the  per- 
sons about  hirn.  On  the  subsidence  of  one  of  these  attacks,  he  gradually  sunk,  at  a  quarter 
past  four  o'clock  on  the  morning  of  the  15th  of  November. 

"  I  was  assisted  in  the  post-mortem  examination  of  the  brain  by  Dr.  Todd  and  Mr.  Bow- 
man, of  King's  College,  and  I  am  indebted  to  the  kindness  of  the  former  distinguished  phy- 
siologist for  the  following  account  of  the  morbid  appearances. 

"  The  scalp  was  pale  and  bloodless,  like  the  rest  of  the  body,  which  was  much  emaciated. 
The  dura  mater  healthy.  The  vessels  on  the  superficies  of  the  brain  were  tinged  with  dark 
blood,  but  there  was  no  sub-arachnoidal  effusion.  The  arachnoid  cavity  was  natural.  On 
the  surface  of  the  right  hemisphere  of  the  brain,  both  under  the  arachnoid  and  pia  mater, 
there  was  a  deposit  of  tubercular  matter  in  patches  of  irregular  shape  and  size,  but  the  whole 
occupying  a  surface  of  about  two  inches  square.  The  deposit  was  most  abundant  on  the 
surface  of  the  convolutions;  it  nevertheless  descended  into  the  sulci  between  them,  a  cir- 
cumstance which  proved  its  connection  with  the  deep  surface  of  the  pia  mater.  -The  corti- 
cal substance  of  the  brain  in  contact  with  the  tubercular  matter  was  reddened  and  greatly 
softened;  and,  on  microscopic  examination,  evinced  a  nearly  total  destruction  of  the  tubules 
in  it;  a  great  enlargement  of  the  proper  globules  of  the  gray  matter,  and  of  the  pigment 
granules  which  adhere  to  them.  The  softening  extended  a  slight,  way  into  the  subjacent 
white  matter.  On  the  edge  of  the  left  hemisphere,  corresponding  to  the  diseased  patch  of 
the  right,  a  slight  tubercular  deposit  had  taken  place  in  a  similar  manner,  producing  a  red 
softening  of  the  gray  matter  in  contact,  but.  not  occupying  more  than  half  an  inch  square  iu 
surface.  The  ventricles  contained  more  water  than  natural — about  double — and  did  not  col- 
lapse when  laid  open.  The  cerebral  substance  throughout,  excepting  at  the  diseased  part, 
was  firmer  than  usual  at  the  patient's  ago.  This  firmness  was  no  doubt  owing  to  the  com* 
pression  of  the  fluid,  which  probably  at  an  earlier  period  of  the  disease  was  more  abundant. 

"It is,  I  believe,  generally  admitted  that  irritation  of  the  membranes  and  cineritious  sub- 
stance of  the  brain  is  attended  with  convulsion.-,  without  decided  or  persistent  paralysis,  and 
that  it  requires  the  medullary  matter  to  be  involved  to  render  the  paralysis  permanent.  Mjr 
own  observation,  so  far  as  I  have  had  an  opportunity  of  investigating  this  interesting  subject, 
accords  with  this  opinion.  In  the  present  case,  the  paralysis  was  not  persistent  until  after 

22 


338  HUMAN   BRAIN. 

the  violent  attacks  of  cramp,  and  from  this  time  may  probably  be  dated  the  implication  of 
the  medullary  substance  in  the  inflammatory  process.  Admitting  the  justness  of  the  view, 
that  red  softening  of  the  brain  is  the  result  of  chronic  inflammation  of  its  substance,  persistent 
paralysis  was  not  to  be  expected  until  the  inflammatory  action  had  involved  the  medullary 
substance. 

"  On  comparing  the  two  hemispheres,  the  diseased  portions  and  parts  adjacent,  the  left 
presented  evidences  of  more  recent  inflammation  than  the  right;  and  this  was  to  be  ex- 
pected from  the  history  of  the  case." 

Thus  I  think  it  may  be  considered  established  that  meningitis,  though 
always  accompanied  with  derangement  of  the  mind  and  temper  to  a 
greater  or  less  extent,  is  in  many  cases  accompanied  with  derangement 
of  the  motor  powers.  The  character  of  these  lesions  of  motion  depend 
upon  the  extent  of  the  disease.  In  the  early  stage,  before  it  has  ad- 
vanced far,  different  kinds  of  spasms  exist,  from  a  mere  trembling  or 
subsultus  tendinum  up  to  the  most  violent  contractions. 

"  Convulsions,  properly  so  called,"  says  Andral,*  "are  among  the  most 
common  phenomena  accompanying  acute  meningitis.  These  are  some- 
times, though  very  rarely,  general.  When  partial  they  are  sometimes 
confined  to  the  same  part,  at  other  times  they  affect  different  parts  of  the 
body  successively.  The  parts  most  usually  affected  with  convulsive 
motions  in  meningitis  are,  the  globes  of  the  eyes,  the  eyelids,  the  face, 
the  lips,  and  finally  the  extremities.  Tonic  spasms,  as  they  are  called, 
are  not  less  frequent  than  clonic,  in  the  disease  now  under  considera- 
tion ;  thus  permanent  flexion  of  the  forearm  on  the  arm  is  often  observed. 
Retroversion  of  the  head,  its  inclination  to  the  right  or  left,  are  sometimes 
observed  in  cases  of  meningitis,  as  also  tetanic  rigidity  of  the  jieck,  trunk 
or  extremities,  trismus,  &c. 

"  Under  the  second  class,  in  which  motion  is  diminished  or  altogether 
destroyed,  may  be  reckoned  those  numerous  varieties  of  paralysis  ob- 
served in  meningitis.  This  paralysis  may  affect  the  muscles  of  the  eye, 
of  the  eyelids,  face,  lips,  or  limbs  ;  either  one  or  several  of  these  may  be 
deprived  of  motion.  In  these  different  parts  the  paralysis  may  be  estab- 
lished either  slowly  or  as  instantaneously  as  the  loss  of  motion  succeed- 
ing cerebral  hemorrhage.  The  paralysis  may  supervene  from  the  com- 
mencement, or  succeed  one  of  the  forms  of  spasms  already  mentioned  ; 
it  may  alternate  with  these  spasms  ;  it  may,  in  fine,  co-exist  with  them  ; 
and  we  have  witnessed,  more  than  once,  one  of  the  upper  extremities 
completely  deprived  of  motion,  whilst  the  other  was  more  or  less  vio- 
lently convulsed.  There  are  also  some  cases  in  which  the  paralysis 
appears  and  disappears  by  turns;  a  phenomenon  which  will  not  surprise 
us,  when  we  have  seen  that  in  meningitis,  paralysis  can  exist  only  when 
there  is  compression  of  the  brain.  Simple  hyperaemia  of  the  pia  mater, 
slight  purulent  infiltration  of  this  membrane,  are  capable  of  producing  it, 
or,  to  speak  more  accurately,  are  capable  of  producing  in  the  brain  that 
modification,  inappreciable  after  death,  which  gives  rise  to  it." 

Dr.  Abercrombief  makes  the  following  acute  observations  on  a  form 
of  meningitis  which  I  have  more  than  once  had  the  opportunity  of  ob- 
serving : — 

11  A  dangerous  modification  of  the  disease,  which  shows  only  increased 
vascularity. 

*  P.  51.  t  P-  61>  §  viii. 


INFLAMMATION   OF    THE   HEMISPHERICAL   GANGLION.  339 

"Another  important  modification  of  the  disease  occurs  in  an  insidious 
and  highly  dangerous  affection,  which,  I  think,  has  been  little  attended 
to  by  writers  on  the  diseases  of  the  brain.  It  is  apt  to  be  mistaken  for 
mania,  or  in  females  for  a  modification  of  hysteria  ;  and  in  this  manner 
the  dangerous  nature  of  it  has  sometimes  been  overlooked,  until  it  proved 
rapidly  and  unexpectedly  fatal.  It  sometimes  commences  with  depres- 
sion of  spirits,  which,  after  a  short  time,  passes  off  very  suddenly,  and  is 
at  once  succeeded  by  an  unusual  degree  of  cheerfulness,  rapidly  followed 
by  maniacal  excitement  In  other  cases  these  preliminary  stages  are  less 
remarkable;  the  affection,  when  it  first  excites  attention,  brings  us  its 
more  confirmed  form.  This  is  in  general  distinguished  by  remarkable 
quickness  of  manner,  rapid  incessant  talking,  and  rambling  from  one 
subject  to  another,  with  obstinate  watchfulness  and  a  small  frequent 
pulse.  Sometimes  there  is  hallucination,  or  conception  of  persons  and 
things  which  are  not  present,  but  in  others  this  is  entirely  wanting.  The 
progress  of  the  affection  is  generally  rapid  ;  in  some  cases  it  passes  into 
convulsion  and  coma,  but  in  general  it  is  fatal,  by  a  sudden  sinking  of 
the  vital  powers,  supervening  upon  the  high  excitement,  without  coma. 
The  principal  morbid  appearance  is  a  highly  vascular  state  of  the  pia 
mater,  sometimes  with  very  slight  effusion  between  it  and  the  arachnoid. 
The  disease  is  one  of  extreme  danger,  and  does  not  in  general  admit  of 
very  active  treatment.  General  bleeding  is  not  borne  well,  and  the 
treatment  must  in  general  be  confined  to  topical  bleeding,  with  purga- 
tives, antimonials,  and  the  powerful  application  of  cold  to  the  head. 
The  affection  is  most  common  in  females  of  a  delicate,  irritable  habit, 
but  also  occurs  in  males,  especially  in  those  who  have  been  addicted  to 
intemperance.  I  have,  however,  seen  it  in  one  case,  in  a  gentleman 
between  40  and  50,  of  stout  make  and  very  temperate  habits.  The 
cause  of  death  is  obscure;  it  seems  in  general  to  be  a  sudden  sinking  of 
the  vital  powers,  supervening  upon  the  high  excitement,  without  any  of 
the  actual  results  of  inflammation." 

The  following  cases  are  related  by  Dr.  Abercrombie  to  illustrate  this 
class  of  symptoms,  and  the  first  is  one  of  those  cases  which  illustrate 
inflammation  from  within,  excited  by  mental  causes.  The  color  of  the 
hemispherical  ganglion  unfortunately  was  not  noted,  but  the  inflamma- 
tion of  the  pia  mater  without  that  of  the  arachnoid  is  particularly  de- 
scribed. 

Case  37. — A  lady,  aged  23,  had  suffered  much  distress  from  the  death  of  a  sister,  and  had 
been  affected  in  consequence  with  impaired  appetite  and  want  of  sleep.  This  had  gone  on 
for  about  two  months,  when,  on  the  4th  of  August,  1825,  she  sent  for  Dr.  Kellie,  and  said 
she  wished  to  consult  him  about  her  stomach.  He  found  her  rambling  from  one  subject  to 
another  with  extreme  rapidity  and  considerable  incoherence;  and  on  the  5th,  she  was  in  a 
state  of  the  highest  excitement,  with  incessant  talking,  alternating  with  screaming  and  sing- 
ing: pulse  from  80  to  90.  In  the  evening  she  became  suddenly  calm  and  quiet  after  an 
opiate ;  continued  so  for  an  hour  or  more,  then  fell  asleep,  and  after  sleeping  two  hours,  awoke 
in  the  same  state  of  excitement  as  before.  The  same  symptoms  continued  on  the  Gth;  the 
pulse  in  the  morning  was  little  affected,  but  after  this  time  it  became  small  and  very  rapid. 
On  the  7th,  after  a  night  of  great  and  constant  excitement,  she  had  another  lucid  interval,  but 
her  pulse  was  now  150.  The  excitement  soon  returned,  and  continued  till  four  in  the  after- 
noon, when  she  fell  asleep.  She  awoke  about  eight,  calm  and  collected,  but  with  an  evi  lent 
tendency  to  coma;  pulse  150,  and  small.  She  now  took  food  and  wine,  and  passed  the  night 
partly  in  a  state  of  similar  excitement,  and  partly  comatose;  and  died  about  midday  of  the 
8th,  having  continued  to  talk  incoherently,  but  knowing  those  about  her,  and  in  general  uru 
derstanding  what  was  said  to  her. 


340  HUMAN    BRAIN. 

Inspection. — The  only  morbid  appearance  that  could  be  discovered  was  a  highly  vascular 
state  of  the  pia  mater,  with  numerous  red  points  in  the  substance  of  the  brain. 

Case  38. — A  gentleman,  aged  44,  of  a  stout  make,  and  very  temperate  habits,  ber-ame  sud- 
denly affected,  without  any  known  cause,  with  extreme  depression  of  spirits,  accompanied 
by  a  good  deal  of  talking  and  want  of  sleep.  After  this  condition  had  continued  for  two 
days,  it  went  off  suddenly,  and  he  recovered  excellent  spirits  and  talked  cheerfully.  This, 
however,  was  soon  succeeded  by  a  state  of  excitement,  with  rapid  incoherent  talking,  and 
obstinate  watchfulness,  and  the  pulse  rose  rapidly  to  160.  This  state  continued  without 
abatement  for  about  four  days,  when  he  suddenly  sank  into  a  state  of  collapse,  and  died. 

Inspection. — The  only  morbid  appearance  was  a  highly  vascular  state  of  the  pia  mater  and 
arachnoid,  with  slight  serous  effusion  betwixt  them. 

There  is  a  case  related  by  Morgagni,  Epist.  LXII.  No.  5,  something 
similar  to  the  last. 

Case  39. — The  patient  in  the  first  instance  was  lalx>ring  under  a  false  impression,  which, 
producing  excessive  fear,  was  followed  by  tremors,  convulsions,  pain  in  the  head,  and  loss 
of  speech,  but  not  of  consciousness.  He  died  seven  days  after  the  appearance  of  the  first 
symptoms,  and  the  morbid  appearance  discovered  after  death  was  merely  congestion  of  the 
pia  mater. 

Although  headache  is  the  usual  concomitant  of  meningitis,  still  there 
are  cases  in  which  this  symptom  is  absent.  Out  of  twenty-eight  cases 
reported  by  Andral,*  there  were  sixteen  in  which  the  headache  existed, 
and  twelve  in  which  this  symptom  was  not  observed  ;  but  in  these  twelve 
there  was  one  case  in  which  the  patient  was  not  minutely  watched,  and 
another  in  which  the  delirium  having  existed  from  the  commencement, 
the  pain  of  the  head  could  not  be  complained  of  by  the  patient. 

In  the  sixteen  cases  in  which  the  pain  did  exist,  the  alterations  dis- 
covered after  death  were  as  follows  : — In  two  of  these  cases  the  patients 
presented  tumors  developed  primarily  in  the  dura  mater,  which  had  com- 
pressed the  nervous  substance  in  contact  with  them.  In  two  other  cases 
an  effusion  of  blood  existed  in  the  great  cavity  of  the  arachnoid. 

In  two  subjects,  no  other  alteration  was  observable  but  considerable 
effusion  of  liquid  serum  into  the  cerebral  ventricles.  Three  other  sub- 
jects presented  nothing  but  redness  of  the  meninges.  Another  case 
presented  pseudo-membranous  concretions  deposited  within  the  great 
arachnoid  cavity. 

In  five  post-mortem  examinations  the  pia  mater  was  found,  whether  of 
the  convexity  or  of  the  base,  infiltrated  with  pus.  In  one  of  these  five 
there  were  also  found  cellular  adhesions  intimately  connecting  together 
the  two  reflections  of  the  arachnoid  covering  the  convexity  of  the  brain. 
This  individual  had  been  all  his  life  tormented  with  headache. 

In  only  one  case  were  the  ventricles  found  filled  with  purulent  fluid. 
'*  From  these  facts,"  says  Andral,  "  we  are  warranted  in  concluding  that 
the  pain  accompanying  diseases  of  the  rneningis  may  exist  with  diseases 
of  these  membranes,  widely  differing  from  each  other  both  in  their  nature 
and  their  seat. 

44  Let  us  now  inquire  what  lesions  were  found  in  the  membranes  in 
the  twelve  patients  who  complained  not  of  headache.  In  two  of  them 
the  pia  mater  was  infiltrated  with  pus,  either  the  portion  of  it  extended 
over  the  convexity  of  the  cerebral  hemispheres,  or  that  covering  the  base 
of  the  brain.  A  sero-purulent  liquid  filled  the  ventricles  in  one  case. 

44  From  these  facts   it  follows  that  the   diseases  of  the   membranes, 

*  P.  47. 


INFLAMMATION    OF    THE    HEMISPHERICAL    GANGLION.  341 

during  which  no  headache  was  observed,  differed  neither  in  their  nature 
nor  in  their  seat  from  those  in  which  pain  of  the  head  was  one  of  the 
symptoms."  Andral  goes  into  the  details  of  this  subject  with  great  care, 
and  his  facts  are  worthy  of  attention. 

"  It  has  not  been  found,"  he  says,  "  that  the  different  degrees  of  the 
intensity  of  the  headache  depended  either  on  the  nature  of  the  lesions  of 
the  membranes,  or  on  their  seat.  We  have  found  it  as  acute  in  cases 
where  there  was  but  simple  injection  of  the  pia  mater,  as  in  those  where 
the  pia  mater  was  infiltrated  with  pus,  or  where  a  false  membrane  covered 
the  arachnoid.  With  respect  to  the  seat  of  the  lesions,  we  find  that,  in 
cases  where  the  headache  was  most  intense,  some  related  to  meningitis 
of  the  convexity  of  the  hemispheres;  others  to  meningitis  of  the  base  of 
those  hemispheres;  others  to  inflammation  of  the  entire  membranes  sur- 
rounding the  nervous  centres;  others,  again,  to  effusions  of  pus  or  serum 
into  the  ventricles. 

"Between  these  cases  and  those  where  the  pain  of  head  was  either 
much  weaker,  or  none  at  all,  we  do  not  find  any  difference  with  respect 
to  the  lesions;  and  in  order  to  explain  so  many  varieties,  we  are  always 
obliged  to  admit  individual  dispositions,  which,  with  lesions  apparently 
identical,  produce,  according  to  the  subjects  affected,  phenomena  of  the 
most  different  kind. 

"  The  nature,  also,  of  the  pain  felt  by  patients  attacked  with  menin- 
gitis is  not  the  same  in  all.  Some  think  that  there  is  an  enormous  weight 
on  their  skull;  some  complain  of  violent  lancinating  pain  either  con- 
tinued or  returning  at  intervals;  several  fancy  that  a  tight  band  com- 
presses their  forehead  ;  some  say  that  their  head  is  squeezed,  as  it  were, 
in  a  vice.  AH  motion  applied  to  the  head,  or  even  to  the  other  parts  of 
the  body,  is  oftentimes  intolerable.  We  have  seen  some  patients  whose 
headache  was  increased  by  slight  pressure  made  on  the  integuments  of 
the  cranium.  We  never  saw,  on  the  contrary,  this  pressure  diminish  the 
headache,  as  so  often  happens  in  the  cases  of  headache  called  nervous. 
The  period  when  the  headache  appears  is  not  the  same  in  all  cases. 
Most  frequently,  however,  it  shows  itself  from  the  commencement,  some- 
times dull  at  first,  and  gradually  becoming  intense  ;  sometimes,  on  the 
contrary,  attaining  at  once  its  maximum  of  severity.  In  several  cases  of 
our  own,  in  very  many  published  by  MM.  Parent  and  Martinet,  and  in 
nearly  all  those  of  M.  Dance,  the  pain  of  head  showed  itself  from  the 
very  commencement.  The  cases  in  which  headache  marks  the  com- 
mencement of  the  disease  seem  divisible  into  two  series,  according  as 
the  headache  develops  itself  singly,  without  any  other  morbid  pheno- 
menon accompanying  it,  or  according  as  its  appearance  coincides  with 
that  of  other  symptoms.  The  first  series  includes  the  most  numerous 
cases.  The  time  during  which  the  headache  continues,  the  only  appre- 
ciable morbid  phenomenon  may  vary  from  some  hours  to  several  days. 
When  this  headache  thus  precedes  the  other  symptoms,  there  are  some 
cases  in  which  it  seems  to  have  nothing  serious  in  it.  It  sometimes  re- 
sembles mere  rheumatic  pain  ;  sometimes  it  might  be  taken  for  neuralgia. 
There  are  some  individuals  who  for  some  time  seemed  to  have  merely  a 
megrim  more  or  less  violent ;  the  mistake  was  easily  fallen  into  in  those 
cases,  where,  a  little  after  the  appearance  of  the  headache,  vomiting 


342  HUMAN    BRAIN. 

supervened.  The  second  series  includes  those  cases  in  which  the  head- 
ache still  presenting  itself  at  the  commencement,  is  accompanied,  from 
the  moment  of  its  appearance,  by  other  symptoms,  whether  of  mere 
febrile  commotion,  or  of  different  disturbances  of  innervation.  There 
are  some  rare  cases  in  which  the  pain  of  head  continues  with  great  in- 
tensity during  the  entire  disease  ;  but  most  frequently  there  are  developed 
on  the  part  of  the  nervous  system  more  severe  symptoms,  which  soon 
prevent  it  from  being  perceived  or  complained  of  by  the  patient.  It 
may  then  be  laid  down  that  the  pain  of  head  generally  exists  only  during 
the  first  period  of  meningitis.  It  is  very  uncommon  to  see  it  come  on 
after  this  period.  Headache  is  almost  the  only  modification  ef  sensibility 
observed  in  the  ordinary  cases  of  meningitis.  In  some  few  of  the  cases 
reported  by  us,  the  cutaneous  sensibility  was  rendered  rather  obtuse; 
but  it  may  be  remarked,  that  in  one  of  them  the  brain  itself  was  the  seat 
of  considerable  pressure,  made  by  a  tumor  developed  in  the  dura  mater. 
There  was  one  case  also  where  the  sensibility  was  very  much  exalted. 
From  several  cases  published  by  M.  Parent  and  also  by  M.  Dance,  we 
feel  warranted  in  laying  it  down,  that  in  the  meningitis  of  adults,  modi- 
fications observed  in  the  cutaneous  sensibility  may  be  considered  as  mere 
exceptions  ;  when  they  do  exist,  they  are  to  be  referred  to  a  peculiar 
disposition  in  the  subject,  and  not  to  any  specific  lesion." 

The  great  practical  point,  as  it  appears  to  me,  with  regard  to  the  infor- 
mation derivable  from  the  existence  of  pain  in  the  head,  its  peculiar 
character,  seat,  and  duration,  in  the  diagnosis  of  cerebral  disease,  is 
this — that  pain  alone  cannot  be  regarded  as  affording  any  instruction, 
but  that  when  it  is  weighed  in  the  balance,  with  other  signs  significant 
of  disease  of  the  nervous  system,  then  the  character  and  seat  of  the 
pain  become  important. 

For  instance,  if  the  patient  has  violent  pain  in  the  head,  but  the  temper 
and  mind  are  not  unusually  disturbed  and  excited,  and  there  is  no  indi- 
cation of  incipient  paralysis  or  irritability  of  the  muscular  system,  no 
insornnolence  except  such  as  would  be  occasioned  by  severe  pain  in  any 
part  of  the  body,  then  is  the  pain  no  indication  of  cerebral  disease.  But 
if,  with  such  symptoms  as  above  described,  the  patient  complains  of  pain 
in  the  head,  then  is  its  existence  a  most  important  sign  of  inflammatory 
mischief,  requiring  more  or  less  local  depletion  and  derivation  of  the 
blood  to  other  organs;  the  intestinal  canal  with  its  extended  surface 
always  affording  an  open  field  for  rapid  evacuation  of  the  nutritive 
fluids. 

The  whole  subject  of  headache  is  one  of  great  interest,  but  regarding 
its  pathology  we  have  still  much  to  learn.  Dr.  Bright*  observes — u  That 
this  symptom  depends  on  various  causes,  and  that  it  is  connected  with 
different  conditions  of  the  circulation  in  the  brain,  is  not  improbable; 
but  in  by  far  the  majority  of  cases  the  actual  condition  of  the  vessels  at 
the  moment  of  the  existence  of  headache  is  a  state  of  congestion.  Ex- 
haustion from  fatigue,  exhaustion  from  the  loss  of  blood,  exhaustion 
from  over  excitement  by  mental  exertion  or  bodily  excesses,  all  tend  to 
produce  a  state  of  debility  in  the  vessels  of  the  brain  which  favors  con- 

*  Op.  cit.,  p.  222. 


INFLAMMATION    OF    THE    HEMISPHERES.  343 

gestion ;  and  these  are  the  more  ordinary  circumstances,  under  which 
headache  occurs.  The  headache  which  follows  apoplectic  and  epileptic 
attacks,  that  which  torments  the  hysteric  female,  and  that  which  so  often 
attends  on  the  dyspeptic  stomach,  all  probably  depend  on  cerebral  con- 
gestion variously  modified  and  combined,  according  to  the  causes  which 
give  rise  to  it,  or  to  the  peculiar  state  of  the  constitution  in  which  it 
occurs." 

I  am  acquainted  with  a  gentleman  who  suffers  occasionally  from  dys- 
peptic headache  ;  and  indiscretion  in  diet  will  bring  it  on,  especially  if 
he  has  been  at  all  worried  in  business  and  much  confined  in  London. 
But  his  headaches  are  always  hemicranial,  confined  entirely  to  one  side 
of  the  head.  And  they  alternate  regularly  ;  for  instance,  if  he  has  a  pain 
on  the  right  side  one  week,  and  the  pain  has  entirely  disappeared,  the 
next  time  it  will  be  strictly  confined  to  the  left  side.  Sometimes  the 
pain  is  so  severe  as  to  keep  him  awake  at  night,  and  if  he  falls  asleep 
it  will  awake  him.  A  slight  mercurial  purgative  will  always  remove  it 
when  very  severe  ;  cold  applications  relieve  it,  all  motion  aggravates  it, 
and  the  contact  of  the  foot  with  the  ground  jars  the  head ;  it  does  not 
affect  the  mind  even  at  the  time  of  its  duration,  and  leaves  no  ill  effects 
afterwards.  Does  this  depend  on  local  congestion  ?  I  can  scarcely 
believe  so.  Nor  do  I  see  any  reason  for  attributing  it  to  anaemia. 

From  these  cases,  which  seem  to  illustrate  the  effect  of  inflammation 
on  the  instruments  of  volition  and  the  organs  of  intellect,  let  us  next 
turn  to  the  consideration  of  inflammation  of  the  substance  of  the  hemi- 
spheres— the  tubular  neurine  ;  the  following  cases  certainly  demonstrate 
that  the  sensibility  may  be  exalted  first,  and  impaired  afterwards,  as  well 
as  that  muscular  contraction  may  be  excited  first,  and  destroyed  after- 
wards, without  the  intellect  being  affected,  when  the  inflammation  is 
confined  to  that  portion  of  the  cerebral  substance  which  is  within  the 
gray  matter  of  the  convolutions,  that  matter  remaining  itself  unaffected. 
The  important  conclusions  which  may  be  drawn  from  these  facts,  regard- 
ing the  office  of  these  two  portions  of  the  brain,  are  equally  interesting 
to  the  physiologist  and  the  practitioner. 

I  believe  that  inflammation  of  the  substance  of  the  hemispheres,  or 
rather,  it  should  be  said,  of  the  tubular  portion,  is  characterized  by  the 
appearance  of  convulsions  previous  to  any  sign  of  mental  excitement. 
This  inflammation  frequently  terminates  very  rapidly  in  ramollissement. 

This  form  is  extremely  insidious  f  the  absence  of  any  disturbance  of 
the  intellectual  faculties  prevents  the  attention  of  the  patient  and  the 
friends  being  called  to  the  ailment  as  serious  in  its  nature. 

The  headache  which  accompanies  it  is  generally  slight,  but  still  if  the 
patient  is  intelligent,  and  can  describe  the  pain  he  suffers,  he  will  say 
that  it  is  different  from  any  he  ever  felt  before,  that  it  is  not  severe  pain, 
but  that  it  is  a  most  uncomfortable  feeling.  There  is  another  symptom 
of  a  most  serious  import,  and  one  which  should  never  be  neglected — it 
is  vomiting. 

The  convulsions  are  occasionally  followed  by  coma  and  then  all  doubt 
regarding  the  danger  of  the  attack  is  at  rest:  though  it  is  true,  as  stated 
by  Dr.  Abercrombie,  that  sometimes  after  the  coma  has  lasted  for  a  cer- 
tain time,  perhaps  for  twelve  hours,  there  is  a  complete  recovery  from 


344  HUMAN   BRAIN. 

it,  and  for  several  days  the  patient  appears  to  be  in  a  favorable  state  ; 
when,  without  any  warning,  the  convulsion  returns,  and  terminates  in 
fatal  coma.  If  there  is  one  thing  more  inexplicable  than  any  other  in 
cerebral  diseases,  it  is  their  cessation  and  remission,  sometimes  amount- 
ing to  an  almost  regular  periodical  intermittent.  But  still  the  effect  of 
quinine  in  such  cases  is,  like  other  stimulants,  deleterious. 

In  the  early  stage  of  this  complaint  the  pupil  may  not  be  affected,  but, 
generally  speaking,  if  the  case  is  carefully  and  constantly  watched,  one 
pupil,  if  the  disease  is  very  limited  (and  it  is  quite  extraordinary  how 
isolated  and  limited  the  seat  of  inflammation  frequently  is)  will  be  found 
first  contracted  and  afterwards  dilated.  Injuries  of  the  head  have  been 
already  cited  as  among  the  causes  which  produce  inflammation  of  the 
hemispherical  ganglion,  and  thus  affect  the  intellect;  we  must  again  refer 
to  them  in  relation  to  the  tubular  substance  beneath,  and  the  effect  on 
the  conducting  instruments  of  the  brain,  as  shown  by  involuntary  con- 
vulsive actions  of  the  muscles.  When  an  injury  to  the  head  is  immedi- 
ately followed  by  convulsions,  it  is  generally  a  sign  of  very  serious  and 
severe  injury  to  the  substance  of  the  brain,  usually  a  laceration. 

When  convulsions,  after  a  few  days,  supervene  on  a  blow  of  the  head, 
they  must  be  promptly  attended  to,  as  indicative  of  inflammatory  mis- 
chief in  the  tubular  structure  or  under  surface  of  the  ganglion.  The 
following  case  illustrates  this  subject  well : — 

Case  40. — Thomas  Smith,  aged  14,  was  admitted  from  Woolwich  into  George's  Ward,  St. 
Thomas's  Hospital,  under  Mr.  Solly,  as  Mr.  Green's  assistant,  May  llth,  1846,  stated  to  have 
fallen  from  a  scaffold  about  twenty  feet  high,  pitching  upon  his  head.  When  picked  up  he 
was  found  quite  insensible,  and  bleeding  from  the  right  ear.  The  accident  occurred  at  7 
A.M.,  when  he  was  sent  to  the  hospital,  and  seen»by  Mr.  Solly  at  half-past  9  A.M.  He  had 
been  insensible  up  to  the  time  of  admission,  and  continued  so  at  that  time.  His  head  was 
shaved,  and  cold  lotion  applied;  at  half-past  1  p.  M.  he  had  recovered  his  senses;  his  pulse 
was  somewhat  slow  and  laboring;  pupils  dilated,  particularly  the  left,  but  contracting  upon 
the  admission  of  light;  he  complained  of  pain  in  the  head,  and  was  very  drowsy. 

At  9  P.M.  was  much  the  same  as  in  the  middle  of  the  day. 

Treatment. — 9  A.M.,  Hydr.  Chlor.  gr.  v.  stat.  sum  end. 

2  P.  M. — R.  Hydr.  Chlor.  gr.  ij.  quaque  2d>-  hora  surnenda.    Himd.  xx.  ad  caput  applicand. 

9  P.M. — Venesectio  ad  5jxij. 

May  12th,  8£  A.M. — Complains  still  of  pain  in  the  head;  continues  drowsy;  pulse  72; 
bowels  not  opened,  although  he  has  taken  eight  doses  of  calomel. 

8^  A.  M. — Hirud.  xxx.  Hydr.  Chlor.  gr.  v.  quaque  hora  donee  alvus  saluta  sit. 

I  P.M.— Pergat. 

II  P.M. — Enema — statim,  repr>  donee  alvus  solnta  sit. — Sleeping;  sensible  when  roused, 
but  complains  of  his  head,  more  particularly  the  left  side.      Bowels  not  yet  open;    has 
taken  nine  5-grain  doses  of  calomel :  the  calomel  to  be  omitted  till  morning. 

May  13th. — Sleeping;  not  easily  roused,  but  quite  sensible  when  awake;  answers — I 
have  got  the  headache,  sir — then  dozes  off  again.  Pulse  64.  Bowels  opened  twice  by  the 
enema;  stools  lumpy  and  dark  brown.  Hydr.  Submur.  gr.  v.  mane  primo. 

1  P.M. — Rather  more  drowsy;  becoming" forgetful.     Hirudines  xxx.  applicantur. 

7  p.  M. — The  sister  observed  that  he  had  slight  grating  of  the  teeth,  and  almost  immedi- 
ately afterwards  thrust  his  tongue  from  his  month,  which  remained  out ;  the  right  arm  was 
at  the  same  time  drawn  up,  and  there  was  working  of  the  eyes.    The  sister  thought  he  was 
conscious,  but  he  could  not  speak ;  she  then  sent  off  immediately  for  Mr.  Solly. 

8  P.M. — Countenance  more  anxious;  not  so  easily  roused ;  answers  less  readily  ;  speaks 
in  a  more  drawling  way;  pulse  76,  not  so  full.     Mr.  Solly  opened  a  vein  in  the  arm,  but 
the  blood,  which  was  very  dark,  flowed  so  slowly  that  he  opened  the  temporal  artery;  the 
patient  was  raised  from  the  pillow,  and  as  soon  as  a  little  more  than  an  ounce  of  blood 
had  flown,  he  had  a  convulsive  fit,  it  was  slight,  and   accompanied   by  a  low  moan.     The 
artery  was  then  divided,  and  he  laid  again  on  the  pillow,  the  bleeding  being  stopped.     He 
almost  immediately  recovered  his  consciousness,  his  countenance  was  pale,  and  his  surface 
covered  with  a  cool  sweat.     Pulse  56,  irregular.     After  a  few  minutes  he  seemed  a  little 


INFLAMMATION   OF    THE    HEMISPHERES.  345 

more  conscious,  and  said,  in  answer  to  a  question,  that  he  was  easier.  R.  Hydr.  c.  Creti 
gr.  ij.  4tis-  horis. 

May  14th. — Says  lie  is  very  bad,  but  seems  more  conscious;  has  had  no  more  convulsions ; 
says  that  his  head  aches.  Pulse  72,  soft;  month  a  little  tender. 

9  r  M. — Countenance  better;  more  cheerful;  head  cooler;  pulse  80;  pergat ;  says  he  is 
a  little  better. 

About  11  P.  M.,  he  had  a  convulsive  fit,  very  short,  mouth  drawn  to  the  right  side,  foamed 
at  the  mouth,  did  not  scrram ;  a  few  minutes  before,  he  had  started  up  in  bed,  and  would 
have  fallen  out  but  for  his  attendant;  he  had  several  such  fits  during  the  night. 

May  15th,  8£  A.M. — Countenance  very  heavy  and  dull,  scarcely  answers  any  questions  ; 
right  side  of  face  slightly  paralyzed,  also  the  right  arm;  can  feel  when  pinched,  bu^  not 
readily;  bowels  not  open  ;  pergat. 

7£  P.M. — Has  had  seven  or  eight  fits  during  the  day,  not  of  great  length  or  severe. 
Countenance  much  the  same;  answers  questions  slowly,  but  rationally;  bowels  relieved 
this  afternoon;  motions  loose  and  green;  pulse  80;  pergat.  Acet.  Lyttae,  pectori.  Ungt. 
Hydr.  to  the  blistered  surface. 

May  16th. — Pulse  80:  not  so  conscious,  or  well  in  other  respects. 

May  17th. — V<ery  drowsy,  little  conscious;  has  frequent  fits:  countenance  bad;  pulse 
140  ;  cannot  get  him  to  take  any  food. 

May  18th. — Much  worse;  countenance  anxious;  can  scarcely  answer  any  questions  f 
says  he  wants  his  breakfast;  always  expressing  a  feeling  of  hunger.  Pulse  150,  small. 
Has  convulsions  every  ten  minutes. 

May  19. — Countenance  worse,  and  more  anxious;  says  that  he  is  better,  and  the  pains  in 
the  head  less,  but  has  greater  difficulty  in  speaking.  Pergat. 

May  20th. — Countenance  much  the  same;  says  he  is  a  little  better,  but  does  not  appear 
so  ;  pupils  act  to  light ;  right  arm  paralyzed,  but  not  the  leg.  Convulsions  continue.  Pergat. 

May  21. — Convulsions  not  so  frequent  in  occurrence,  but  continue  for  a  greater  length  of 
time,  and  are  more  violent;  he  is  not  so  drowsy,  his  countenance  is  improved,  and  he  is 
perfectly  conscious;  says  he  has  less  pain  in  his  head;  pulse  130;  bowels  open;  tongue 
cleaner. — Continue  treatment. 

May  22d. — The  convulsions  continue  very  violent,  but  occur  less  frequently  than  yester- 
day ;  still  pain  in  the  head;  pupils  contract  to  light;  pulse  120 ;  bowels  open  ;  says  he  feels 
better. 

May  23d. — Little  alteration  as  regards  the  frequency  and  violence  of  the  convulsions  ; 
has  the  power  of  moving  his  right  arm,  which  was  paralyzed  on  Wednesday,  and  can  close 
his  hand  ;  countenance  much  improved  ;  pulse  120 :  bowels  open. — Continue  treatment. 

May  24. — Has  had  no  fit  since  last  night ;  almost  entirely  recovered  the  use  of  his  right  arm, 
and  appears  much  relieved,  the  pain  in  the  head  being  less  severe ;  countenance  good  ; 
tongue  cleaning ;  bowels  open;  pulse  112;  complains  of  his  gums  being  tender. — Continue 
treatment.  Lotio  frigida  ad  caput  applicanda. 

May  25th. — Continues  free  from  fits;  has  quite  recovered  the  power  in  his  right  arm. 
Pulse  108 ;  bowels  open :  appetite  improved.  Cont.  Piluke  nocte  maneque.  Omitt.  Ungti- 
applicatio. 

May  26th. — Has  passed  a  very  good  night;  no  recurrence  of  the  fits;  pain  in  the  head 
slight,  and  confined  to  the  frontal  region;  bowels  open;  pulse  108. 

May  27th. — Says  he  is  better;  has  but  little  pain  in  the  head ;  countenance  good ;  tongue 
cleaner;  pulse  112  ;  bowels  confined.  Ordered  by  Mr.  Solly  to  take  Compd-  Colocynth  pill 
ten  grains,  to  be  repeated,  if  necessary ;  he  had  a  relief  shortly  afterwards,  consequently 
the  aperient  was  not  administered. 

May  28th. — Is  progressing  favorably. 

June  3d. — His  gums  being  still  tender,  and  he  generally  much  improved,  to  take  the  mer- 
cury less  frequently.  R.  Hydr.  c.  Creta  (gr.  ij.)  alt.  noct. 

June  7th. — Is  much  better  ;  says  he  has  no  pain  in  the  head  or  elsewhere  ;  bowels  open ; 
tongue  clean  ;  appetite  good  ;  pulse  90. 

June  13th. — Appears  and  describes  himself  as  feeling  quite  well,  and  is  rapidly  gaining 
strength.  The  use  of  the  mercury  to  be  discontinued. 

Presented,  June  29th,  quite  well. 

I  believe  that  the  pathological  course  of  this  case  was  thus  :  first, 
concussion  of  the  brain,  with  either  slight  fracture  or  displacement  of 
bones  at  the  base  of  the  skull,  as  indicated  by  the  bleeding  at  the  right 
ear;  serious  injury  to  the  right  side  of  the  brain,  indicated  by  dilatation 
of  the  left  pupil,  taken  in  connection  with  the  bleeding  from  the  right 
ear.  The  injury  of  the  brain  confined  to  the  base,  indicated  by  the  ab- 


346  HUMAN   BRAIN. 

sence  of  much  intellectual  disturbance;  effusion  of  blood  into  the  tubu- 
lar structure  not  in  sufficient  quantity  to  produce  immediate  paralysis, 
but  sufficient  to  irritate  and  excite  inflammation,  indicated  by  the  spas- 
modic action  and  convulsions;  effusion  of  lymph  consequent  on  the  in- 
flammation indicated  by  the  paralysis;  arrest  of  inflammation  by  blood- 
letting and  mercury  ;  absorption  of  lymph  by  continued  action  of  mercury, 
restoration  of  the  injured  brain — recovery. 

I  never  examined  after  death  a  case  in  which  inflammation  was  limited 
to  the  tubular  portion  of  the  hemispheres.  In  those  cases  on  record 
where  this  occurred,  the  disease  was  ushered  in  with  headache,  then 
convulsions,  soon  followed  by  paralysis :  if  the  disease  extends  upwards 
and  outwards  to  the  hemispherical  ganglion,  then  the  mental  faculties 
will  be  more  or  less  excited  and  perturbed  ;  if  downwards  to  the  ven- 
tricles, then,  effusion  taking  place,  coma  is  the  consequence. 

The  following  case  (and  I  think  it  supports  my  view  of  its  pathology) 
"is  in  point  after  the  last ;  I  shall  designate  it  acute  stimulation  of  the 
motor  tract,  as  well  as  the  hemispherical  ganglion.  It  is  from  Andral.* 

Case  41. — dcute  meningitis  limited  to  the  convexity  of  the  left  hemisphere  of  the  brain;  delirium ; 
convulsive  movements  of  the  face  and  extremities  of  the  right  side. — A  tailor,  37  years  of  age,  had 
been  sick  four  or  five  days  when  he  entered  the  hospital,  17th  July,  1821.  On  the  15th  of 
this  month,  without  any  known  cause,  he  was  seized  with  violent  pain  of  the  head,  particu- 
larly seated  in  the  frontal  region.  On  the  day  after,  the  headache  continued,  and  the  pain 
became  more  general,  being  extended  now  to  the  parietal  and  occipital  regions.  On  this 
day  he  lost  his  appetite,  and  vomited  some  drink  he  had  taken.  In  the  evening  constant 
nauseau  still  appeared,  followed  from  time  to  time  by  a  throwing-up  of  some  bitter  yellow 
matter. 

On  the  17th  the  headache  continued,  but  the  vomiting  ceased  ;  some  nausea  still.  Hav- 
ing entered  the  hospital,  he  presented,  on  the  next  day's  visit,  the  following  state : — face  re- 
markably pale ;  pain  of  head,  the  precise  seat  of  which  cannot  be  pointed  out  by  the  patient; 
at  intervals  this  becomes  so  very  severe  as  to  make  him  utter  piercing  cries  ;  eyes  dim  and 
languid  ;  slight  involuntary  motion  of  the  muscles  which  move  the  commissure  of  the  lips; 
his  answers  accurate  ;  gives  a  perfect  account  of  his  state,  and  of  everything  which  hap- 
pened to  him  since  the  commencement  of  his  illness ;  the  pulse  moderately  frequent  and 
regular ;  everything  else  natural. 

It  was  difficult  to  assign  a  precise  seat  to  this  group  of  symptoms ;  the  first  complaints, 
however,  regarded  the  head ;  the  vomiting  might  be  considered  as  connected  with  a  com- 
mencing cerebral  affection,  and  the  severe  headache  seemed  to  point  out  the  head  as  the  seat 
of  disease.  The  absence  of  any  morbid  phenomenon  with  respect  to  the  alimentary  canal, 
repelled  the  idea  that  the  headache  was  sympathetic  of  gastro-intestinal  irritation.  The  ab- 
sence of  all  febrile  disturbance  precluded  the  possibility  of  its  being  mere  continued  fever. 
The  state  of  the  patient,  however,  appeared  very  alarming ;  the  appearance  of  his  counte- 
nance, and,  amidst  the  absence  of  local  symptoms,  the  great  alteration  already  of  his  features, 
obliged  us  to  form  a  rather  unfavorable  prognosis.  M.  Lerminier  suspecting  a  state  of  ence- 
phalic congestion,  applied,  notwithstanding  the  extreme  paleness  of  his  face,  twenty  leeches 
across  each  jugular  vein.  Demulcent  drinks,  and  sinapisms  to  the  lower  extremities.  No 
change  in  the  patient  on  the  following  morning. 

On  the  20th  he  was  very  much  cast  down,  and  answered  questions  with  difficulty  and  re- 
luctance; light  was  painful  to  him  ;  he  kept  bis  eyes  closed  and  his  head  concealed  under 
the  bedclothes ;  face  very  pale;  pain  of  head  not  great;  the  convulsive  movements  of  the 
lips  more  frequent  and  more  marked;  pulse  and  skin  natural.  (Blister  to  the  nape  of  tho 
neck.)  In  the  night  he  emerged  from  a  state  of  stupor,  in  which  he  had  been  for  the  last 
twelve  hours.  He  got  up  out  of  bed  suddenly,  saying  that  some  persons  were  pursuing  him 
to  do  him.  harm.  He  raved  during  the  night,  and  occasionally  uttered  several  piercing 
cries. 

On  the  21st he  was  kept  in  bed  by  force.  The  face  had  now  become  red;  the  head  was 
agitated  by  a  continual  movement,  which  carried  it  from  right  to  left,  and  left  to  right ;  the 
muscles  moving  the  lips,  the  aloe  nasi,  and  the  eyebrows,  were  in  the  highest  degree  of  con- 


Case  VI.,  p.  6,  op.  cit. 


INFLAMMATION    OF    THE    HEMISPHERES.  347 

vulsive  agitation ;  saliva,  slightly  frothy,  flowed  in  great  abundance  from  the  mouth  ;  he 
spoke  incessantly  and  with  energy, but  his  articulation  was  unintelligible;  great  subsultus 
tendinum,  which  prevented  the  pulse  from  being  felt;  its  frequency  did  not  seem  very  great. 
(Bleeding  from  the  arm,  twenty  leeches  to  the  neck,  cold  applications  to  the  head.)  No 
change  on  the  2 1  st. 

On  the  22d,  violent  delirium;  convulsive  motions  of  the  muscles  of  the  face;  risus  sar- 
donicus ;  continued  motion  of  the  right  arm ;  subsultus  increased ;  pulse  more  frequent ;  tongue 
moist  and  red.  (Two  blisters  to  the  thighs ;  ice  to  the  head.) 

On  the  23d,  head  turned  back,  and  to  the  right;  strong  contraction  of  the  right  arm;  re- 
spiration very  irregular;  occasionally  accelerated;  it  then  becomes  slower  than  natural.  The 
patient  silent  and  quite  still ;  eyes  fixed,  and  void  of  expression ;  mouth  open  and  unmoved; 
pupils  neither  contracted  nor  dilated;  answers  no  questions;  does  not  even  seem  to  under- 
stand them;  original  paleness  of  face  returned;  pulse  sixty  a  minute,  and  regular;  bowels 
not  free ;  tongue  cannot  be  seen  ;  teeth  not  dry.  He  remained  quite  torpid  during  the  day, 
but  at  night  violent  delirium  re-appeared;  uttered  very  loud  cries. 

On  the  24th,  this  excitement  was  succeeded  by  profound  coma;  extremities  cold ;  a  clammy 
sweat  covered  the  face ;  respiration  ralaut.  Died  in  the  course  of  the  day. 

Sectio  cadav. — On  the  upper  surface  a  considerable  difference  in  the  color  of  the  two  cere- 
bral hemispheres,  the  right  being  pale,  while  the  left  presented  a  well-marked  red  tint,  which 
resided  entirely  in  the  sub-arachnoid  cellular  tissue,  which  was  traversed  by  numerous  ves- 
sels; neither  serum  nor  pus  in  the  tissue;  the  gray  substance,  constituting  the  most  superficial 
portion  of  the  convolutions  of  the  left  hemisphere,  participates  in  the  injection  of  the  pia 
mater  covering  it.  The  ventricles  contained  scarcely  two  spoonsful  (cuilleries  a  cafe}  of 
serum;  nothing  remarkable  in  the  rest  of  the  brain  The  lungs  infarcted  posteriorly;  the 
heart  contained  in  its  right  cavity  a  large  fibrinous  clot,  deprived  of  its  coloring  matter;  the 
mucous  membrane  of  the  stomach  very  thin  towards  its  great  cul-de  sac. 

Case  42. — Softening  of  the  right  cerebral  hemisphere;  acute  pains  in  the  left  extremities,  which 
subsequently  became  paralyzed,  still  continuing  painful* — A  woman,  71  years  old,  had  felt,  for 
about  a  year  before  entering  the  hospital,  acute  pains  in  the  two  extremities  of  the  left  side. 
These,  which  were  at  first  transient,  became  lancinating,  occupying  particularly  the  anterior 
surface  of  the  upper  extremity,  and  the  posterior  surface  of  the  lower  extremity. 

When  they  were  intense,  they  gave  rise  occasionally  to  slight  convulsive  twitches  of  the 
fingers,  and  particularly  of  the  index  finger;  occasionally,  too,  but  only  after  or  during  a  pain, 
the  thumb  was  flexed  on  the  palm  of  the  hand,  the  flexion  never  lasting  beyond  ten  or  twelve 
minutes.  This  was  the  first  time  the  patient  experienced  such  pains;  by  degrees  they  be- 
came more  frequent,  and  at  last  continued ;  but  at  the  same  time,  they  abated  of  their  origi- 
nal severity,  and  ultimately  the  patient  only  felt  in  the  extremities  of  the  left  side,  and  par- 
ticularly in  the  upper,  a  sensation  of  formication.  She  continued  thus  for  five  months;  she 
then  ceased  to  be  able  to  sustain  herself  on  her  left  leg  as  well  as  before;  this  limb  seemed 
to  her  dull  and  heavy,  and  she  dragged  it  a  little  in  walking.  At  this  time  also  the  left  upper 
extremity  became  weaker;  she  could  no  longer  grasp  or  hold  any  weighty  object  with  the 
hand  of  this  side.  By  degrees  this  paralysis  increased,  and  at  the  end  of  six  weeks  it  was 
as  complete  as  possible.  But,  what  was  extraordinary,  from  the  time  the  muscles  of  the 
extremities  of  the  left  side  were  entirely  deprived  of  voluntary  motion,  the  pains  which  had 
marked  the  commencement  of  the  disease  returned  with  their  original  severity ;  and  from 
time  to  time  they  increased  so  as  to  make  her  shed  tears.  This  was  the  state  she  was  in 
when  she  was  submitted  to  our  inspection.  She  was  at  this  time  emaciated  and  pale,  eyes 
sunk,  features  drawn,  and  expressive  of  long  suffering.  Every  two  or  three  days  the  ex- 
tremities were,  as  it  were,  furrowed  by  acute  pains.  The  skin  of  these  parts  much  more 
insensible  than  those  of  the  limbs  of  the  right  side.  Power  of  motion  completely  destroyed 
in  them;  right  commissure  of  lips  drawn  up;  tongue  deviated  sensibly  to  the  left;  skin  of 
face  on  right  side  less  sensible  than  on  left;  the  intelligence  perfect.  She  told  us,  that  from 
her  nineteenth  to  her  twenty-third  year  she  had  been  tormented  with  violent  beating  of  the 
heart,  accompanied  with  great  difficulty  of  breathing.  These  symptoms,  however,  com- 
pletely disappeared.  After  remaining  about  a  month  in  the  hospital,  a  large  eschar  formed 
on  the  sacrum:  she  gradually  wasted  away;  her  feet  became  cedematous,  and  she  sank  ex- 
hausted, retaining  her  intellect  to  the  last. 

Sectio  cadav. — On  a  level  with  and  external  to  the  optic  thalamus  and  corpus  striatum  of 
the  right  side,  we  found  considerable  softening  of  the  cerebral  substance,  which  extended  to 
the  base  of  the' brain.  Anteriorly  it  was  limited  by  a  line,  the  internal  extremity  of  which 
might  terminate  at  the  junction  of  the  anterior  four-fifths  With  the  posterior  fifth  of  the  cor- 
pus striatum.  Posteriorly  it  extended  nearly  to  the  posterior  extremity  of  the  hemisphere. 
No  ihjection  in  the  softened  portion.  The  softened  cerebral  substance  is  of  a  grayish  white 


*  Andral,  op.  cit,  Case  XV.,  p.  145. 


348  HUMAN    BRAIN. 

in  certain  points,  and  yellowish  in  others.  The  fornix  and  septum  lucidnm  diffluent.  The 
two  lateral  ventricles  distended  with  serum.  The  great  arteries  of  the  brain  ossified.  Heart 
and  lungs  healthy;  some  ossifications  in  the  aortic  valves.  The  gastric  mucous  membrane 
visibly  softened  towards  the  great  cul-de-sac  in  several  points. 

The  lining  membrane  of  the  ventricles  is  sometimes  inflamed  without 
the  arachnoid  on  the  surface  being  affected.  Andral  remarked  that  dis- 
eases of  the  former  are  not  necessarily  connected  with  diseases  of  the 
pia  rnater  surrounding  the  brain,  either  at  its  base  or  convexity. 

When  the  lining  membrane  of  the  ventricles  is  inflamed,  without  the 
hemispherical  ganglion  having  been  previously  attacked,  as  is  usually 
the  case,  the  symptoms  are  peculiar ;  for  the  arachnoid  and  pia  mater 
of  the  surface  are  most  frequently  attacked  in  the  first  instance,  and  that 
of  the  ventricles  subsequently.  The  diagnosis  might  perhaps  be  con- 
sidered more  interesting  in  a  physiological  than  useful  in  a  practical  point 
of  view.  But  such  is  not  the  case,  for  this  form  of  inflammation  is  so 
insidious,  and  its  formidable  character  so  liable  to  be  passed  over  until 
it  is  too  late  to  apply  our  remedies,  that  we  cannot  be  too  much  alive  to 
the  symptoms  which  indicate  its  presence.  The  following  case  illus- 
trates this.  When  I  related  it  to  a  medical  society,  some  very  sound 
and  careful  practitioners  remarked  on  its  close  resemblance  to  many 
cases  of  hysteria  which  were  occurring  daily  in  their  practice. 

Case  43. — In  the  summer  of  1844,  at  2  P.M.,  I  visited  in  consultation  a  young  lady,  set.  15, 
suffering  in  the  following  manner : — I  found  her  lying  on  a  sofa,  her  countenance  much 
flushed,  her  head  hot,  pulse  irregular  and  quick,  but  without  much  power;  strabismus  of  the 
right  eye  towards  the  nose,  both  eyes  bright  and  rather  staring.  She  was  not  able  to  an- 
swer any  questions,  but  sufficiently  conscious  to  open  her  mouth  slightly,  and  partially  pro- 
trude her  tongue,  the  tip  of  which  was  brown  and  dry:  her  right  arm  was  raised  in  the  air 
and  jerked  about  spasmodically;  afterwards  she  picked  the  bedclothes,  but  she  was  unable 
to  move  the  limbs  on  the  left  side  at  all. 

The  gentleman  in  attendance  informed  me  that  he  had  seen  her  occasionally  for  some 
time  past,  with  various  symptoms ;  at  one  time  with  a  cough,  very  similar  to  hooping-cough  ; 
and  on  more  than  one  occasion  suffering  from  severe  affection  of  the  respiratory  organs,  and 
the  next  quite  well :  she  was  also  subject  to  many  hysterical  symptoms.  She  first  men- 
struated one  year  back;  but  she  has  since  been  irregular,  three  months  having  elapsed  with- 
out any  show. 

For  the  present  illness  Mr.  F.  visited  her  six  days  ago ;  he  found  her  with  an  exceedingly 
quick,  small  pulse,  without  anything  apparently  to  account  for  it :  there  was  a  general  dull- 
ness of  expression;  eyes  looking  heavy;  pupils  dilated;  intellect  rather  blunted,  giving  per- 
fectly correct  answers,  only  very  slowly.  She  complained  of  pain  in  the  left  side  of  the 
abdomen,  and  slight  pain  in  the  head.  He  ordered  her  saline  aperients  and  hyoscyamus  in 
very  small  doses. 

Mr.  F.  informs  me  that  no  very  decided  change  took  place  in  her  symptoms  till  the  fourth 
day,  when  she  was  much  worse;  she  complained  of  cold  chills,  and  soon  after  the  parents 
observed  that  the  limbs  on  the  left  side  lay  like  withered  limbs,  arid  those  on  the  right  side 
were  seized  with  convulsive  movements.  She  was  still  sufficiently  sensible  to  complain  of 
the  jerking  of  her  limbs,  which  she  said  were  mad.  Her  intellect  became  gradually  more 
dull,  but  she  was  not  delirious. 

I  told  Mr.  F.  that  I  considered  that  there  was  inflammation  of  the  lining  membrane  of 
the  ventricles,  with  effusion,  and  I  was  afraid  that  there  was  some  softening  about  the 
thalamus,  more  especially  on  the  left  side.  She  died  about  eight  hours  after  I  saw  her. 

Post  mor/fw,  84  hours. — Lody  plump,  slightly  green  over  the  abdomen,  but  otherwise  fresh. 

Head — Convolutions  of  the  upper  part  of  the  brain  flattened;  no  inflammation  of  the 
arachnoid  in  this  situation,  or  sub-arachnoidal  effusion;  slight  softening  of  the  great  trans- 
verse commissure ;  ventricles  filled,  and  distended  with  bloody  serum  mixed  with  some 
pus.  The  lining  membrane  of  the  right  ventricle  slightly  inflamed,  studded  all  over  with 
ecchymosed  spots;  sero-sanguineous  effusion  into  the  left  ventricle;  suppuration,  with  soft- 
ening of  the  right  thalamus,  some  softening  of  the  left,  some  effusion  at  the  base  round  the 
medulla  oblongata. 

Mdomen.— Hydatid  attached  to  each  broad  ligament  of  the  uterus. 


INFLAMMATION    OF    THE    HEMISPHERES.  349 

It  is  sometimes  difficult  to  decide  whether  the  quantity  of  fluid  con- 
tained in  the  ventricles,  is  above  the  normal  quantity,  whether  it  is  in 
morbid  excess.  If  the  arachnoid  and  pia  rnater  are  torn  either  at  the  base 
of  the  brain,  so  as  to  open  the  inferior  cornu  of  the  lateral  ventricles,  or 
at  the  foramen  of  Bichat,  or  at  the  fourth  ventricle,  then  the  fluid  escapes 
before  these  cavities  are  opened.  If  this  fluid  is  greatly  in  excess, 
the  form  of  the  convolutions  and  fossa  digitataB  at  the  vertex  of  the 
brain  indicates  the  fact ;  the  convolutions  are  flattened,  and  the  sides  of 
the  fossae  in  close  contact.  If  we  suspect  an  abnormal  quantity  of  fluid, 
it  is  important  to  mark  their  condition  before  opening  the  ventricles. 

Andral  considers  that  the  presence  of  serum  in  the  ventricles  should 
only  be  considered  the  result  of  a  morbid  process  when  its  quantity  ex- 
ceeds an  ounce  in  each  lateral  ventricle.  Excess  of  serum  is  more  fre- 
quently met  with  in  the  ventricles  than  in  the  external  arachnoidal  sac. 

Andral  remarks,  that  when  the  quantity  is  very  considerable,  the  sep- 
tum lucid  urn  and  fornix  are  always  found  softened. 

It  is  difficult  to  say  whether  this  softening  is  the  result  of  the  same 
inflammatory  action  which  gives  rise  to  the  effusion,  or  whether  it  is  a 
mere  physical  effect  from  imbibition,  as  stated  by  Dr.  Hughes  Bennett. 
I  have  no  doubt  that  it  is  sometimes  one  and  sometimes  the  other,  but 
most  frequently  the  effect  of  inflammation,  and  as  such  to  be  considered. 

Inflammation  of  the  corpus  striatum  does  occur  sometimes,  though 
seldom  without  some  other  portion  of  the  brain  being  involved.  Dr. 
Abercrombie  relates  a  case  in  which  there  was  a  small  abscess  in  both 
corpora  striata,  the  rest  of  the  brain  being  perfectly  healthy. 

In  drunkards,  and  persons  of  excitable  dispositions,  who  are  much 
harassed  with  the  cares  of  life,  I  believe  that  the  brain  is  liable  to  be 
frequently  congested,  and  that  the  blood-vessels  become  permanently 
enlarged. 

M.  Max.  Durand  Fardel*  has  well  pointed  out  the  change  which 
takes  place  in  these  cases.  He  calls  it  a  sieve-like  condition  of  the 
brain,  etat  crible  du  cerveau.  u  These  little  holes  are  usually  surrounded 
by  perfectly  healthy  cerebral  substance.  They  are  circular,  with  well- 
defined  edges,  scattered  irregularly  through  the  brain,  varying  in  dia- 
meter, and  unchanged  in  form  by  a  stream  of  water.  If  water  is  al- 
lowed to  flow  on  them  for  any  time,  the  cerebral  substance  is  gradually 
washed  away,  and  the  little  holes  are  seen  to  have  been  the  artificial 
openings  of  canals,  each  of  which  contained  a  vessel." 

"  The  sieve-like  condition  of  the  brain  is  sometimes  found  unasso- 
ciated  with  any  other  lesion;  at  other  times,  however,  it  co-exists  with 
the  various  forms  of  softening  of  the  brain,  and  especially  with  the 
general  ramollissement  of  the  cortical  layer  of  the  convolutions  which  M. 
Calmeil  has  described  as  peculiar  to  the  general  paralysis  of  the  insane, 
•with  induration  of  the  brain,  &c.  Evidence  exists  to  prove  that  the 
connection  between  the  etat  crible  of  the  brain  and  other  lesions  with 
which  it  is  associated  is  not  merely  accidental;  thus,  in  one  instance,  in 
which  idiotcy,  attended  with  occasional  attacks  of  mania,  followed  a 

*  Ga/ette  Medicale,  Jan.  15th,  1842,  quoted  in  the  British  and  Foreign  Quarterly  Medical1 
Review,  vol.  xiv.  p.  225. 


350  HUMAN   BRAIN. 

blow  on  the  head,  induration  of  the  brain,  and  the  sieve-like  condition, 
were  found  confined  to  that  hemisphere  of  the  cerebrum  on  which  the 
injury  had  been  inflicted.  It  is  not  unusual  in  cases  of  chronic  soften- 
ing of  the  brain  to  meet  with  this  sieve-like  appearance  for  some  dis- 
tance around  the  softened  part,  betokening  the  previous  existence  of 
dilatation  of  the  vessels.  In  the  same  brain,  too,  M.  Fardel  has  met 
-with  recent  ramollissement  and  injection  of  the  vessels,  and  old  ramol- 
lissement with  the  etat  crible" 

From  his  observations,  many  of  which  are  detailed  at  length,  the 
writer  concludes  that  "  the  [etat]  crible  of  the  brain  is  produced  by  the 
presence  of  a  great  number  of  small  canals,  perforated  in  the  cerebral 
tissue,  each  containing  a  little  vessel,  to  the  dilatation  of  which  their 
formation  is  doubtless  owing.  These  canals,  the  existence  of  which  is 
normal  in  some  parts  of  the  brain,  appear  in  a  rudimentary  state,  without 
being  necessarily  morbid,  in  some  persons  in  advanced  life. 

"  The  usual  seat  is  in  the  cerebral  hemispheres,  especially  beneath 
the  convolutions,  but  they  are  likewise  met  with  in  the  cerebral  protu- 
berance, and  in  the  medulla  oblongata. 

"  Though  somewhat  different  in  appearance,  the  little  cavities  so  often 
seen  in  the  corpora  striata  are  probably  of  a  similar  nature. 

"  The  general  or  partial  dilatation  of  a  great  number  of  the  vessels  of 
the  brain  appears  to  be  owing  to  chronic  sanguineous  congestion,  or  to 
frequent  recurrence  of  congestion  of  the  organ. 

u  This  opinion  seems  sufficiently  warranted  by  the  phenomena  ob- 
served during  life,  as  well  as  by  the  alterations  which  are  found  after 
death  to  co-exist  with  the  etat  crible  of  the  brain. 

"  Twice  this  condition  existed  uncombined  with  any  other  appreciable 
lesion  of  the  brain.  In  one  of  these  cases  there  was  simple  dementia, 
in  the  other,  dementia  with  general  paralysis. 

"  It  is  found  associated  with  superficial  ramollissement  of  the  convo- 
lutions in  insane  persons  affected  with  general  paralysis,  with  general 
or  partial  induration  of  the  brain,  and  in  the  centre  of,  or  around,  por- 
tions of  softened  brain. 

"  This  state  probably  existed,  but  escaped  notice  in  cases  where 
grave  cerebral  symptoms  were  not  found  to  have  given  rise  to  any  lesion 
appreciable  after  death." 

In  considering  the  effects  of  inflammation  on  the  cerebral  substance, 
we  must  not  omit  induration.  We  have  already  turned  our  attention  to 
softening,  both  as  the  result  of  anaemia  and  hypersemia,  and  it  may  seem 
strange  that  the  same  action  of  the  capillary  system  should  produce  a 
totally  opposite  condition. 

Induration  of  the  Brain. — The  existence  of  such  an  alteration  in  tex- 
ture is  now  acknowledged  by  all  pathologists,  and  I  believe  it  is  gene- 
rally admitted  to  be  the  result  of  hypersemia  of  the  part.  It  may  seem 
strange  that  inflammatory  action  should  produce  both  softening  and  hard- 
ening, but  such  seems  really  to  be  the  case.  The  induration  accom- 
panying hypertrophy  has  been  already  adverted  to.  It  is  to  the  more 
partial  induration  that  we  must  now  direct  our  attention.  Andral* 

*  Pathological  Anatomy,  p.  75. 


<*-{  INDURATION    OF   THE   BRAIN.  351 

mentions  several  instances.  "  Induration,"  says  this  author,  "  of  the 
centre  of  the  medullary  substance  of  the  cerebral  hemispheres  was  ob- 
served by  M.  Pinel,  in  a  woman  who  died  in  a  state  of  insanity  ;  the 
posterior  and  inferior  margin  of  the  cerebellum  was  also  so  indurated  as 
to  become  almost  fibro-cartilaginous.  M.  Payen  once  found  in  a  child, 
six  years  old,  a  depression  in  the  posterior  third  of  the  left  cerebral  he- 
misphere, which  was  owing  to  the  induration  and  shrinking  of  one  of 
the  convolutions.  The  superjacent  membranes,  which  were  thickened 
and  white,  accurately  defined  the  extent  of  the  diseased  part.  The  girl, 
who  was  of  a  melancholy  temperament,  but  remarkably  intelligent,  had 
from  her  birth  a  contraction  of  the  right  wrist  and  foot,  together  with 
slight  atrophy  and  incomplete  hemiplegia  of  the  same  side." 

Induration  has  been  supposed  by  some  to  be  a  stage  of  inflammatory 
action,  antecedent  to  that  which  produces  softening,  and  seems  very 
probable;  but  it  must  be  considered  of  a  slower  and  less  acute  charac- 
ter. This  is  Dr.  Copland's  opinion,  and  quite  accords  with  my  own 
limited  observation. 

The  fact  of  its  being  so  often  found  in  the  brain  of  lunatics  is  interest- 
ing and  important,  as  throwing  further  light  on  the  pathology  of  that 
disease,  and  pointing  to  the  proper  mode  of  treating  it  medically. 
'-'-General  induration  of  the  brain,"  says  Dr.  Copland,*  "generally  oc- 
casions loss  of  memory,  confusion  of  thought,  and  derangement  of  the 
mental  manifestations,  causing  insanity  without  lucid  intervals.  When 
the  induration  is  advanced  in  degree,  or  considerable  as  to  its  extent, 
or  both,  and  especially  when  its  long  duration  has  been  indicated  by 
continued  mental  derangement,  a  complete  obliteration  of  the  mental 
faculties,  or  fatuity,  is  frequently  its  attendant  towards  the  last  periods 
of  life,  and  may,  therefore,  be  considered  as  the  consequence  of  the  most 
advanced  degrees  of  this  lesion.  The  signs  of  partial  induration  of  the 
brain  will  vary  according  to  the  extent  and  seat  of  the  lesion.  They 
consist  chiefly  of  a  progressive  defect  of  memory,  inattention,  or  an  ina- 
bility to  pursue  a  long  train  of  ideas,  indifference  to  momentary  impres- 
sions, and  to  present  or  future  occurrences,  difficulty  of  articulation,  de- 
rangement of  ideas,  with  partial  and  total  loss  of  the  affections,  appetites, 
and  desires,  and,  ultimately,  increased  loss  of  speech,  palsy,  convulsions, 
or  want  of  power  over  the  muscles, 'fatuity,  general  or  partial  wasting, 
and  death." 

In  connection  with  hypersemic  disease  of  the  brain,  the  practitioner 
must  remember  that  the  scalp  is  liable  to  various  eruptive  diseases;  but 
he  must  not  set  to  work  and  heal  them  by  local  remedies,  like  dis- 
eases of  the  skin  in  other  parts  of  the  body,  without  first  ascertaining 
how  far  they  may  have  been  set  up  by  nature  as  a  safety-valve  to  the 
brain.  In  children,  how  often  do  we  see  eczema  spring  forth  on  the  head 
during  the  irritative  fever  of  dentition,  with  the  very  greatest  advantage 
to  the  child  ;  and  woe  to  the  poor  infant  if  the  eruption  is  suddenly 
checked!  It  ought  to  be  regarded  as  a  kind  adviser,  telling  us  what 
may  be  going  on  within.  It  is  surprising  how  soon  it  disappears  if 
we  lance  the  gums  freely,  and  give  a  grain  or  two  of  gray  powder 

.*      .  fi   r^b 

*  P.221,op.cit. 


352  HUMAN    BRAIN. 

every  other  night,  with  a  little  magnesia  and  rhubarb  every  morning. 
Scarcely  a  week  passes  that  I  do  not  see  two  or  three  such  cases  at  the 
General  Dispensary,  and  I  always  watch  them  with  interest  for  the 
brain's  sake. 

Meningitis  has  been  described  by  some  authors  as  being  occasionally 
epidemic.  It  is  possible  as  a  form  of  fever,  but  in  most  cases  I  think 
that  it  will  be  found  there  is  some  common  moral  cause  which  produces 
it,  rather  than  an  atmospheric  one.  In  the  British  and  Foreign  Quar- 
terly Medical  Review  for  July,  1844,  there  is  an  account,  extracted  from 
the  Memoires  de  PAcad.  Roy.  de  Med.,  Paris,  1843,  of  this  form  of 
disease. 

It  appears  to  have  ravaged  the  garrisons  of  Versailles,  Lyons,  Bay- 
onne,  Groet,  Metz,  Strasburg,  &c.,  and  its  not  being  confined  to  the 
military  gives  it  a  title  to  be  considered  epidemic.  The  predisposing 
causes  were,  extreme  youth  of  the  soldier,  his  having  recently  joined 
the  service,  and  being  unaccustomed  to  military  exercise.  Prolonged 
exposure  to  the  sun,  with  or  without  subsequent  chill,  but,  above  all, 
violent  exercise  followed  by  chill,  appear  to  ha^ve  acted  most  frequently 
as  immediate  causes.  Post-mortem  examinations  detected  injection  of 
the  membranes,  with  effusion  of  red-colored  serosity,  pus  in  the  pia 
mater,  softening  of  the  medullary  substance  of  both  brain  and  spinal 
cord.  The  treatment  recommended  for  simple  meningitis  is  essentially 
antiphlogistic,  accompanied  with  derivatives  to  the  extremities,  purga- 
tives, cold  applications  to  the  head,  &c.:  when  the  cases  were  treated 
on  the  onset  of  the  attack,  this  plan  answered  :.  but  when  the  inflamma- 
tion had  extended  to  the  substance  of  the  encephalon,  then  collapse  was 
so  sudden  and  complete  that  depletion  could  not  be  resorted  to  until  re- 
action had  taken  place.  In  most  of  these  cases,  M.  Rollett,  finding  that 
the  ordinary  modes  of  exciting  such  action  by  blisters,  sinapisms,  and 
ammoniacal  ointment,  fail,  tried  the  actual  cautery  to  the  spine,  and,  at 
the  same  time,  sinapisms  to  the  feet,  vesications  to  the  thigh,  cupping 
to  the  neck,  and  purgative  enemata.  The  cauterization  gave  no  pain, 
but  reaction  took  place  in  an  hour  or  two  afterwards,  and  then  blood- 
letting was  employed.  This  severe  treatment  was  found  much  more 
successful  than  the  older  and  more  usual  course  in  *such  cases. 

In  the  treatment  of  inflammation  of  the  brain,  whatever  the  form  may 
be,  no  time  must  be  lost ;  minutes  are  even  of  importance.  Bleeding, 
both  topical  and  general,  are  important  remedies,  but  they  require  great 
judgment  in  their  application  ;  as  a  general  rule,  venaBsectio  brachii  is 
not  so  useful  as  bleeding  by  leeches  from  the  head.  But  in  cases  where 
there  is  evidence  of  there  having  been  good  constitutional  power  pre- 
vious to  the  attack,  for  during  the  attack  the  pulse  is  very  deceptive, 
and  the  head  is  hot,  and  the  face  flushed,  and  the  disease  is  progressing 
rapidly,  then  general  blood-letting  is  indicated. 

The  following  cases,  related  by  Abercrombie,  illustrate  the  value  of 
general  blood-letting.  The  third  case  shows  that  we  must  not  be  dis- 
couraged in  the  employment  of  this  remedy,  if  we  have  deliberately 
decided  that  it  is  right  to  employ  it,  though  it  does  not  immediately  pro- 
duce a  beneficial  effect. 


TREATMENT    OF    INFLAMMATION    OF    THE   BRAIN.  353 

Case  44. — A  girl,  aged  11,  had  violent  headache  and  vomiting,  with  great  obstinacy  of  the 
bowels,  and  these  symptoms  were  followed  by  dilated  pupil,  and  a  degree  of  stupor  border- 
ing upon  perfect  coma;  pulse  130.  She  had  been  ill  five  or  six  days;  purgatives,  blisters, 
and  mercury  to  salivation,  had  been  employed  without  benefit.  One  bleeding  from  the  arm, 
gave  an  immediate  turn  to  this  case;  the  headache  was  relieved,  the  pulse  came  down  ;  the 
vomiting  ceased;  the  bowels  were  freely  acted  upon  by  the  medicines  which  they  had  for- 
merly resisted,  and  in  a  few  days  she  was  quite  well. 

Case  45. — A  slender  and  delicate  girl,  aged  11,  had  scarlatina  in  a  favorable  form,  in  the 
beginning  of  April,  1820.  About  the  16th  she  was  so  much  recovered  as  to  be  allowed  to 
go  about  the  house.  A  few  days  after  this,  she  was  affected  with  anasarca,  for  which  she 
took  some  medicine,  with  partial  benefit.  About  the  26th,  however,  the  anasarca  had  again 
increased  considerably,  especially  in  the  face,  which  was  very  much  swelled.  In  the  follow- 
ing night  she  had  vomiting.  On  the  27th,  she  complained  of  headache,  which  increased 
rapidly  in  violence;  towards  the  afternoon,  she  became  delirious;  the  pulse  very  frequent, 
about  160.  Soon  after  this  she  was  seized  with  violent  and  general  convulsion,  which  re- 
curred very  frequently  through  the  early  part  of  the  night,  leaving  her  in  a  state  of  profound 
coma.  The  treatment  adopted  during  the  course  of  these  symptoms  was  repeated — general 
bleeding,  to  the  amount  of  28  ounces,  followed  by  topical  bleeding,  purgatives,  antimonial 
solution,  &c.  Towards  midnight  the  convulsion  ceased,  and  some  time  afterward  she  gradu- 
ally recovered  from  the  coma.  On  the  28th  she  was  free  from  any  alarming  symptom; 
during  the  early  part  of  the  day,  pulse  about  108.  In  the  evening  she  was  seized  with  severe 
symptoms  of  pneumonia,  on  account  of  which  she  was  bled  during  the  next  twenty-four 
hours,  to  the  amount  of  upwards  of  thirty  ounces,  besides  bleeding  with  leeches  and  the 
other  usual  remedies.  In  a  few  days  more  she  was  restored  to  perfect  health. 

Case  46. — A  lady,  aged  45,  after  the  menses  had  ceased  for  four  months,  was  seized  with 
headache,  sense  of  weight  in  the  head,  much  oppression,  and  double  vision ;  the  pulse  was 
at  first  72,  but  soon  rose  to  100.  On  the  first  day  she  was  bled  to  twenty-eight  ounces,  with 
little  relief.  On  the  second,  topical  bleeding,  blistering,  and  smart  purging  were  used,  but  the 
symptoms  continued  unabated.  On  the  third  day,  another  bleeding  of  twenty  ounces  gave  a 
turn  to  the  complaint,  and,  in  a  few  days  more,  with  brisk  purging  and  spare  diet,  it  terminated 
favorably.  The  last  symptom  that  yielded  was  the  double  vision.  It  subsided  slowly,  the 
two  images  gradually  approaching  nearer  to  each  other;  but  it  was  not  entirely  gone  for 
nearly  a  fortnight. 

"  Bleeding  by  leeches,"  says  Dr.  Holland,*  "  from  the  haBmorrhoidal 
vessels  might  be  much  more  frequently  employed  than  it  is  in  affections 
of  the  brain,  as  well  as  in  those  of  the  spinal  cord.  I  know  no  mode  in 
which  a  given  quantity  of  blood  can  be  removed  with  equal  effect  in  the 
cases  where  it  is  required.  It  may  be  difficult  to  give  strict  anatomical 
reasons  why  this  should  be  so;  but  what  we  know  on  the  curious  subject 
of  the  changes  of  balance  in  circulation,  will,  at  least,  furnish  illustra- 
tion of  it.  Nor  can  I  doubt  that  something  here  is  due  to  that  peculiar 
relation  between  the  blood  in  the  portal  circulation  and  the  functions 
and  diseases  of  the  brain,  of  which  experience  affords  so  many  remarka- 
ble proofs.  For  the  practice  itself,  we  have  especial  argument  in  the 
frequent  alternation  of  bleeding,  hemorrhoids,  with  headaches,  and  other 
graver  affections  of  the  head  ;  and  also  in  the  serious  effects  which  some- 
times ensue  upon  the  suspension  of  such  discharge,  after  it  has  long  been 
habitual  to  the  system." 

Dr.  Prichardf  observes:  "  The  fact,  that  evacuations  of  blood  from 
the  head  fail  to  afford  relief  in  many  cases  of  nervous  disease,  is  by  no 
means  a  decisive  proof  that  the  affection,  in  this  particular  instance,  does 
not  depend  upon,  or  is  not  connected  with,  increased  vascular  fullness 
in  the  brain,  since  we  often  experience  a  similar  disappointment  in  those 
cases  where  we  know  the  disease  to  consist  in  an  overdistended  state 
of  the  vessels." 


*  P.  55,  op.  cit 

t  A  Treatise  on  Diseases  of  the  Nervous  System,  1522,  p.  236. 

23 


t354  HUMAN   BRAIN. 

Dr.  Prichard*  relates  some  interesting  cases  of  maniacal  disease  cured 
by  the  supervention  of  contagious  fever.  He  had,  he  says,  "  an  oppor- 
tunity of  frequently  witnessing  the  effects  of  fever  communicated  to 
maniacs,  as  male  lunatics  are  placed  in  the  same  ward  with  persons 
laboring  under  contagious  fever."  I  will  select  the  following,  as  I  think 
it  illustrative  of  the  pathology  of  insanity.  The  observations  which  fol- 
low I  entirely  concur  with. 

Case  47. — Anne  Jaunery,  admitted  June  17,  1817. 

Description. — A  married  woman,  aged  28  years,  the  mother  of  three  children.  She  is  of  a 
tall  and  slender  make ;  has  brown  hair,  dark  gray  eyes,  low  forehead,  sharp  features ;  her 
natural  disposition  is  irascible. 

History. — She  has  never  been  before  affected  with  maniacal  symptoms ;  this  attack  is 
supposed  to  have  been  produced  by  intemperance.  Her  husband  is  insane,  and  is  confined 
in  this  house;  his  disorder  is  attributed  to  vexation  in  consequence  of  the  loss  of  property. 

Present  state. — She  is  extremely  irritable ;  talks  incessantly  on  different  subjects  5  frowns, 
and  closes  her  eyes  as  if  intolerant  of  light. 

Treatment. — Shave  her  head ;  Haust.  Cath.  nocte  maneque ;  house  diet. 

July  20. — The  purging  has  been  continued ;  little  or  no  amendment ;  cold  shower-bath  ; 
continue  the  purgatives. 

Aug.  17. — No  improvement  has  taken  place;  pulse  full,  not  quickened;  complains  of 
•weight  and  pain  in  the  head ;  is  drowsy.  She  has  had  an  interview  with  her  husband ; 
neither  of  them  appeared  to  be  aware  of  their  situation.  V.  S.  et  fluant  sang.  ^xvj.  Syn- 
cope followed  blood  of  loose  consistence ;  the  bleeding  relieved  her.  From  this  time  she 
continued  occasionally  with  pain  in  the  head,  attended  with  increased  pulsation  of  the  qaro- 
tid  and  temporal  arteries,  and  a  renewal  of  her  restlessness  and  maniacal  symptoms,  which 
were  generally  relieved  for  the  time  by  the  application  of  leeches  to  the  head,  blisters  to  the 
nape  of  the  neck ;  her  bowels  were  constantly  kept  open,  and  she  generally  used  the 
shower-bath . 

About  the  2d  of  January,  1818,  she  had  a  slight  attack  of  contagious  fever,  which  subsided 
in  about  a  week.  From  that  time  she  gradually  recovered,  and  was  discharged,  cured,  on 
the  26th  of  the  following  June.  Full  diet  was  allowed  her  from  the  time  of  her  becoming 
convalescent  from  fever. 

Observations. — This  was  evidently  a  case  of  inflammatory  congestion  of  the  head.  It  was 
excited  by  dram-drinking,  and  relieved  by  local  depletion;  but  not  cured,  until  a  new  disease 
took  place,  which  altered  the  determination  of  the  vascular  system,  and  overcame  the  tend- 
ency to  congestion  in  the  head. 

Purgatives  and  mercury  are  our  most  valuable  allies  in  combating  in- 
flammatory disease  of  the  brain.  Dr.  Abercrombie  says,  "  In  all  the 
forms  of  the  disease,  active  purging  appears  to  be  the  remedy  from 
•which  we  find  the  most  satisfactory  results  ;  and  although  blood-letting 
is  never  to  be  neglected  in  the  earlier  stages  of  the  disease,  my  own  ex- 
perience is,  that  more  recoveries  from  head  affections  of  the  most  alarm- 
ing aspect  take  place  under  the  use  of  very  strong  purging  than  any 
other  mode  of  treatment."  Dr.  Abercrombie  preferred  croton  oil  as  the 
most  convenient.  I  generally  give  calomel  in  five-grain  doses,  as  we 
'thus  obtain  the  benefit  of  the  specific  powers  of  this  mineral  in  restrain- 
ing inflammation,  as  well  as  its  purgative  effects. 

The  following  case,  from  Dr.  Abercrombie,  illustrates  the  power  of 
purgative  medicines  in  these  diseases : — 

Case48.j- — A  gentleman,  aged  17,  1st  February,  1810,  had  symptoms  of  continued  fever 
for  a  week;  the  skin  then  became  cool,  and  the  tongue  clean  ;  but  he  had  severe  headache, 
•with  considerable  stupor;  pulse  100.  General  bleeding  was  then  employed,  foil  owed1  by 
purging  and  mercurial  frictions,  and  after  a  few  days  the  symptoms  were  alleviated ;  but 
there  was  still  much  headache,  with  oppression,  and  considerable  slowness  of  speech.  On 
the  14th  there  was  increase  of  stupor;  pulse  86;  the  tongue  clean;  the  skin  cool.  On  the 


Op.  cit,  p.  72.    .,  f  Op.  cit,  n.  160,  Duodecimo. 


TREATMENT    OF    INFLAMMATION   OF   THE   BRAIN.  355 

16th  there  was  much  incoherent  talking  and  unmanageable  delirium;  after  which  the 
stupor  again  increased,  the  pulse  continuing  at  84.  On  the  19th,  there  was  partial  relief, 
after  smart  purging ;  but  on  the  20th  the  stupor  had  returned  as  before,  and  by  the  22d  had 
increased  to  perfect  coma  ;  the  pulse  about  100.  He  now  lay  in  a  state  of  perfect  coma  for 
four  days,  during  which  time  various  medicines  were  given  with  difficulty,  and  with  little 
effect  upon  his  bowels.  On  the  27th,  purging  was  produced  to  the  extent  of  fourteen  evacua- 
tions in  the  day,  with  complete  relief  of  all  his  symptoms.  On  the  28th  there  was  some 
delirium,  which  subsided  in  another  day.  For  a  week  he  continued  to  complain  of  some 
headache,  and  a  feeling  of  weight  in  his  head,  but  by  the  10th  of  March  he  was  free  from 
complaint. 

Cold  applications  to  the  head  are  invaluable;  on  the  whole,  pounded 
ice  in  a  large  bladder  is  perhaps  the  best.  If  this  cannot  be  procured, 
then  any  evaporating  lotion,  such  as  spirit  of  wine  and  water,  but  this 
must  be  constantly  changed  ;  and  the  effect  is  very  much  increased  by  a 
current  of  air  thrown  upon  it  with  the  bellows. 

The  best  refrigerator,  after  all,  is  the  cold  douche,  but  then  the  patient 
should  be  in  a  warm  bath  ;  or,  if  this  is  not  possible,  his  feet  should  be 
placed  in  warm  water.  It  can  always  be  administered  by  pouring  water 
from  a  height  of  about  five  or  six  feet  out  of  a  common  washing-stand 
jug.  It  is  so  powerful  a  remedy  that  it  must  be  used  with  caution.  The 
writer,  to  whom  I  last  referred,  says  that  he  has  seen,  under  the  opera- 
tion of  it,  a  strong  man  thrown,  in  a  very  few  minutes,  into  a  state 
approaching  to  asphyxia,  who  immediately  before  had  been  in  the 
highest  state  of  maniacal  excitement,  with  morbid  increase  of  strength, 
defeating  every  attempt  of  four  or  five  men  to  hold  him. 

Regarding  the  use  of  cold  to  the  head,  Dr.  Henry  Holland  makes  the 
following  excellent  practical  observations  :* — 

"  There  are  one  or  two  lesser  points  in  the  treatment  of  affections  of 
the  brain  deserving  more  discrimination  than  they  usually  obtain.  One 
of  these  is  the  general  use  of  ice,  or  other  cold  applications,  to  the  head. 
Any  influence  of  cold,  through  its  effect  on  the  capillary  vessels  of  the 
head,  is  at  least  ambiguous  in  such  cases  ;  and  though  its  direct  sedative 
effects  on  the  nervous  system  may  afford  more  certain  warranty  for  the 
practice,  yet  these  require  to  be  distinguished  and  watched  over  in  their 
progress.  For,  even  where  relief  is  distinctly  obtained  from  cold  sud- 
denly applied  after  embrocation,  it  by  no  means  follows  that  this  appli- 
cation, long  continued,  will  produce  or  maintain  a  like  benefit.  It  is 
well  known  in  various  parts  of  practice  how  far  it  is  otherwise  ;  and 
that  the  effect  of  cold  upon  the  circulation  and  nervous  system  is  some- 
times even  reversed,  according  to  the  amount  and  manner  in  which  it  is 
applied.  Or  allowing,  as  I  readily  do,  that  there  may  be  a  distinct 
sedative  effect  from  cold,  beneficial  in  cases  of  inflammation  of  the  brain 
or  its  membranes,  will  this  equally  apply  to  apoplectic  cases,  where 
pressure  occurs  from  fullness  of  vessels  or  extravasation?  If  the  relief 
to  some  kinds  of  headache  be  alleged,  it  must  be  remembered  that 
other  headaches  are  increased  by  this  means.  The  same  disparity, 
doubtless,  exists  as  to  the  more  serious  affections  of  this  organ  requiring 
discrimination  wherever  we  can  exercise  it.  Unfortunately  these  are 
cases  in  which,  generally,  patients  can  render  least  aid.  Sometimes  they 
are  manifestly  uneasy  under  the  application  of  cold.  Their  feeling, 
whenever  it  can  be  ascertained,  is  better  than  any  other  test." 

*  P.  47,  op.  dt. 


356  HUMAN    BRAIN. 

I  have  found  aconite,  antimony,  and  digitalis,  each  and  all  most  use- 
ful medicines  in  subduing  inflammation  of  the  brain. 

The  value  of  aconite  is  well  shown  in  the  case  of  Betsey  Rankin — 
Meningitis  from  fracture  of  the  skull.  Antimony  I  have  not  used  much, 
as  I  have  considered  it  too  depressing  in  its  operation.  Digitalis  is  more 
useful  in  chronic  cases  than  in  the  acute. 

I  have  long  felt  convinced  that  much  of  the  obscurity,  which  envelops 
these  diseases,  and  those  of  other  parts  of  the  brain,  mi^ht  be  removed 
by  comparing  them  with  diseases  of  the  eye  ;  viewing  them  through  the 
light  which  the  observation  of  this  interesting  class  of  affections  affords 
us.  I  do  not  refer  so  much  to  acute  disease  as  chronic,  though  both  are 
useful  as  instructors.  One  great  reason  why  these  affections  of  the  eye 
ought  to  guide  us  in  our  treatment  and  prognosis  of  inflammation,  both 
chronic  and  acute  in  other  organs,  is  the  facility  with  which  we  can  ob- 
serve the  action  of  remedies,  medicines,  topical  applications,  general 
stimulants,  and  diet,  upon  an  organ  so  open  to  observation.  I  believe 
that  every  form  of  mental  derangement  is  dependent  on  some  change, 
though  often  very  slight  and  temporary,  of  the  vital  condition  of  the 
hemispherical  ganglion. 

I  arn  convinced  that  the  reason  why  physicians,  to  whom  the  treatment 
of  the  insane  has  been  entrusted,  believe  in  the  existence  of  mental  dis- 
ease unattended  with  disease  of  the  instrument  which  the  mind  employs 
in  its  communications  with  the  world,  is  because  the  medicine,  both 
constitutional  and  local,  has  so  little  control  over  these  diseases,  and  the 
great  good  to  be  derived  from  moral  treatment.  A  knowledge  of  the 
treatment  of  diseases  of  the  eye  would  teach  them  a  different  lesson. 
Let  any  man  ignorant  of  the  treatment  of  ophthalmic  diseases  attempt 
the  cure  of  a  case  of  strumous  ophthalmia;  he  would,  in  all  probability, 
seeing  the  red,  inflamed  conjunctiva,  the  pain  suffered  by  the  patient, 
and  the  distress  occasioned  by  the  presence  of  light,  employ  all  the  most 
approved  antiphlogistic  measures.  He  would  bleed  from  the  arm,  purge 
violently,  and  then  possibly  put  his  patient  under  the  influence  of  mer- 
cury. What  would  be  the  consequence?  Why,  most  assuredly  the  loss 
of  the  eye,  total  blindness.  And  the  same  sad  results  followed  the  treat- 
ment of  insanity  when  it  was  considered  to  be  an  inflammation  of  the 
brain,  except  in  very  acute  cases  occurring  in  subjects  with  much  con- 
stitutional power;  injudicious  treatment  being  attended  in  the  one  case 
with  the  loss  of  sight,  in  the  other  with  the  loss  of  intellect.  But  sup- 
pose a  judicious  surgeon,  one  bred  in  the  school  of  Farre,  Travers, 
Lawrence,  and  my  late  respected  colleague,  Frederic  Tyrrell,  called 
upon  to  treat  this  strumous  inflammation  of  the  eye.  He  would  support 
his  patient's  general  health  with  a  tonic  plan  of  treatment ;  he  would 
improve  the  condition  of  the  circulating  fluid  and  the  instruments  which 
circulate  it.  He  would  endeavor  to  arrest  local  inflammation  by  small 
local  blood-lettings,  counter-irritants,  and  astringent  lotions,  by  remov- 
ing him  from  all  those  atmospheric  influences  and  moral  circumstances 
which  would  stimulate  the  organ.  And  thus  he  might  ultimately  suc- 
ceed; but  what  care,  what  patience,  and  what  confidence  in  the  reme- 
dial agents  employed,  does  it  require  on  the  part  of  the  surgeon  who 
Jtreats  these  cases,  to  effect  a  cure ! 


TREATMENT    OF    INFLAMMATION    OF    THE    BRAIN.  357 

If,  then,  it  is  so  difficult  to  subdue  an  inflammation  in  an  organ,  the 
actual  condition  of  whose  blood-vessels  we  can  view,  to  which  we  can 
actually  apply  local  remedies,  and  from  which  we  can  withdraw  the  in- 
jurious agents  which  have  produced  this  inflammation,  and  exclude  the 
natural  stimulus  of  the  organ,  and  see,  in  the  whole  course  of  our  reme- 
dial measures,  the  progress  or  the  failure  of  each  particular  plan  of  treat- 
ment, is  it  astonishing  that  men  should  have  failed  so  much  in  the  treat- 
ment of  chronic  and  strumous  inflammation  of  the  arachnoid,  pia  mater, 
and  hemispherical  ganglion,  when  they  have  all  these  difficulties  to  con- 
tend with,  and  want  many  of  the  adjuncts? 

Mr.  Tyrrell,  in  his  lectures,  used  to  relate,  in  illustration  of  the  im- 
portance of  a  generous  diet  and  tonic  medicine  in  the  cure  of  chronic 
asthenic  ophthalmia,  the  case  of  a  young  gentleman  who  was  brought  to 
him  by  his  father,  an  intelligent  medical  man,  on  account  of  the  obstinacy 
of  the  ophthalmia  from  which  he  was  suffering.  The  father  had  been 
employing  antiphlogistic  measures.  Mr.  Tyrrell  said,  "  Before  I  pre- 
scribe for  your  boy,  go  and  give  him  a  good  dinner,  and  a  pint  of  porter." 
The  father  was  thunderstruck,  the  boy  delighted,  for  he  had  had  nothing 
but  water-gruel,  &c.,  for  the  previous  week.  The  father  did  as  he  was 
told,  the  same  principle  was  extended  to  the  prescriptions,  and  the  boy 
soon  got  well. 

Now,  supposing  that  this  inflammation,  instead  of  being  of  the  eye, 
where  it  could  be  seen,  had  been  an  inflammation  of  the  brain,  where  it 
could  not  be  seen,  the  existence  of  which  could  only  be  conjectured  from 
symptoms,  and  the  physician  had  prescribed  the  same  phlogistic  treat- 
ment, with  the  same  success,  he  would  adduce  it  as  a  proof  that  there 
had  been  no  inflammation  at  all. 

Again,  the  cures  that  are  effected  by  moral  treatment  alone,  are  often 
brought  forward  as  a  proof  that  mental  diseases  are  unconnected  with, 
and  independent  of,  corporeal  diseases.  It  would  be  just  as  correct  to 
say  an  inflammation  of  the  eye  was  no  inflammation  of  the  eye,  because 
such  inflammation  is  sometimes  cured  by  placing  a  patient  in  a  dark 
room,  and  removing  the  part  from  the  injurious  stimulus  of  light  and 
atmospheric  influences. 

The  moral  treatment  of  the  insane  is  no  more.  It  essentially  consists 
in  the  removal  of  injurious  stimuli,  soothing  and  tranquilizing  the  organ. 

Strumous  ophthalmia  has  been  alone  adverted  to  in  illustration  of  this 
view,  but  there  are  many  other  ophthalmic  affections  which  are  equally 
in  point,  and  the  consideration  of  which  will,  I  think,  be  found  equally 
instructive:  iritis,  choroiditis,  and  amaurosis,  but  especially  the  last. 

The  treatment  of  iritis  is  chiefly  instructive  in  demonstrating  the 
superiority  of  mercury  over  blood-letting  in  subduing  a  deep-seated 
inflammation,  and  the  necessity  of  bringing  your  patient  rapidly  under 
its  influence,  to  prevent  the  consequence  of  adhesive  inflammation. 

Amaurosis,  consequent  on  chronic  choroiditis,  is,  I  believe,  almost 
pathologically  identical  with  mental  imbecility,  consequent  on  chronic 
meningitis. 

In  the  first  case,  the  delicate  structure  of  the  retina,  the  vesicular 
neurine  which  expanded  on  the  optic  nerve,  has  been  pressed  upon  by 


358  HUMAN    BRAIN. 

its  vascular  and  serous  membrane,  the  choroid  and  membrana  Jacobi, 
thickened  by  morbid  deposit. 

In  the  second,  the  vesicular  neurine  of  the  hemispherical  ganglion  is 
pressed  on  by  the  thickened  pia  mater  and  arachnoid. 

And  most  certainly  the  success  which  attends  perseverance  in  the 
treatment  of  chronic  choroiditis  and  amaurosis  ought  to  encourage  us  to 
similar  patience  and  perseverance  in  the  treatment  of  chronic  menin- 
gitis. 

I  have  known  Mr.  Tyrrell  cure  most  obstinate  cases  of  amaurosis  by 
persevering  in  the  administration  of  small  doses  of  mercury,  generally 
two  grains  of  gray  powder  every  night,  or  every  other  night,  for  twelve 
months,  taking  care  never  to  affect  the  mouth.  Indeed,  he  used  to  say 
that  he  has  often  seen  the  cure  of  such  a  case  arrested,  sometimes  en- 
tirely prevented,  by  rapid  salivation,  in  consequence  of  the  impatience 
of  the  invalid,  or  want  of  judgment  on  the  part  of  the  practitioner. 
Mr.  Tyrrell  told  me  that  he  had  often  given  mercury  in  small  doses  for 
two  months  without  any  improvement  in  vision,  but  this  has  not  dis- 
couraged him,  and  that,  by  proceeding  with  the  plan,  he  has  ultimately 
restored  many  a  poor  fellow  to  sight,  whose  case  had  been  abandoned 
as  hopeless.  Mercury  is  in  disrepute  in  the  treatment  of  insanity,  be- 
cause, as  I  believe,  it  has  not  always  been  judiciously  administered. 

Mercury  will  often  restore  the  sight  in  amaurosis,  even  where  the 
perception  of  light  is  destroyed.  Mr.  Tyrrell  used  to  consider  that  a 
case  was  not  entirely  hopeless,  if  the  globe  retained  its  natural  consist- 
ency; neither  abnormally  hard,  or  soft  and  shrunken:  for  when  the  disease 
is  of  very  long  continuance,  then  the  retina  and  vitreous  humor  become 
sometimes  implicated  in  the  morbid  action,  and  partial  atrophy  ensues. 

If  we  could  apply  the  same  test  in  our  diagnosis  and  prognosis  of 
cerebral  affections,  we  should  administer  our  remedies  with  more  con- 
fidence, as  it  is  almost  impossible  to  say  when  the  ganglion  has  become 
atrophied,  and  when  it  is  still  unchanged  in  structure.  In  these  amau- 
rotic  cases  it  is  not  merely  necessary  to  sustain  the  mercurial  action  for 
months,  but  at  the  same  time  the  power  and  tone  of  the  patient's  con- 
stitution must  be  sustained  by  a  good  nutritious  diet  and  a  moderate  quan- 
tity of  stimulus.  Mr.  Tyrrell's  words  are,*  UI  consider  that  the  safety 
of  the  treatment,  and  its  efficacy,  depend  very  greatly  upon  the  support 
of  the  general  power;  for  whilst  this  is  properly  sustained,  I  believe 
that  the  remedy  cannot  produce  any  general  injurious  effect,  though  its 
operation  upon  the  local  disease  may  proceed  most  beneficially.  Unless 
the  general  power  be  maintained,  the  effects  of  the  mercurial  action  on 
the  system  are  extremely  distressing  and  injurious;  and  it  can  rarely  be 
continued  long  enough  to  remedy  the  amaurosis."  These  observations 
result  from  great  practical  experience ;  not  only  in  ophthalmic  diseases, 
but  in  other  surgical  affections,  in  which  the  continued  and  free  use  of 
mercury  is  of  the  greatest  use  in  arresting  and  subduing  diseased  action. 

Case  49. — Mr.  T.  relates  the  case  of  a  man  about  thirty-eight  years  of  age,  who  had  been 
amaurotic  for  seven  years,  and  had  lost  the  perception  of  light;  but  the  globes  possessed 
their  natural  firmness  and  elasticity;  the  pupils  were  clear,  but  irregular,  from  many  points 


*  Cyclopaedia  of  Surgery>  L  p.  91. 


TREATMENT    OF   INFLAMMATION   OF   THE   BRAIN.  359 

of  adhesion  between  the  pupillary  margin  of  the  iris,  and  the  anterior  capsule  of  the  lens ; 
the  irides  were  discolored  and  dull,  and  he  had  the  vacant  aspect  of  a  blind  person.  I  ad- 
mitted him  into  the  infirmary,  then  in  Charter-House-square,  and  put  him  under  mercurial 
treatment,  with  a  nutritious  diet;  as  soon  as  the  mouth  became  tender,  a  considerable  degree 
of  s^Ierotitis  occurred,  with  pain  and  tenderness  of  the  eyeballs;  the  plan  was,  however, 
steadily  continued,  and  some  belladonna  was  applied,  night  and  morning,  to  each  eyebrow; 
he  soon  became  sensible  of  light,  and  gradually  acquired  the  power  of  discerning  objects, 
and,  at  the  same  time,  the  adhesions  between  the  iris  and  the  capsule  of  the  lens  began  to 
give  way,  and  the  pupils  to  re-assume  their  natural  figures;  by  degrees  the  vision  improved, 
all  appearance  of  inflammatory  action  subsided,  the  pupils  became  nearly  regular,  and  the 
irides  brilliant;  the  full  mercurial  action  was  kept  up  for  above  sixteen  weeks,  when  the 
amaurosis  was  completely  subdued,  and  his  vision  perfect.  For  about  sixteen  weeks  he  dis- 
charged alxmt  a  pint  and  a  half  of  saliva  daily,  but  in  spite  of  the  severity  of  the  treatment, 
he  came  out  of  the  course  improved  in  appearance  and  evidently  increased  in  bulk. 

The  more  I  see  of  these  affections  of  the  brain,  the  more  am  I  con- 
vinced that  the  same  rules  ought  to  guide  us  in  the  treatment  of  these 
cases  and  ophthalmic  affections.  The  great  indisposition  to  the  use  of 
medicine  on  the  part  of  those  to  whom  the  medical  treatment  of  the  in- 
sane is  entrusted  impels  me  to  strengthen  my  position  by  such  authority 
as  Mr.  Tyrrell's.  I  know  many  medical  men  who  decidedly  avow  that 
medicine  has  no  control  over  insanity,  and  that  they  never  think  of  giving 
medicine  unless  the  secretions  are  at  fault,  and  there  is  general  fever. 
Mr.  Tyrrell's  observations  on  choroiditis  so  exactly  accord  with  my 
ideas  regarding  meningitis,  that  I  shall  quote  them.*  The  italics  are  my 
own. 

"  The  commencement  of  organic  disease  of  the  choroid,  although 
unattended  by  any  marked  symptoms  of  inflammatory  action,  demands 
serious  attention  and  careful  management ;  the  patient  being  otherwise 
constantly  liable  to  a  sudden  burst  of  inflammation  and  its  consequences. 

"  The  existence,  then,  of  a  network  or  gauze,  or  the  appearance  of 
large  spots  in  the  field  of  vision,  unaccompanied  by  pain  or  uneasiness, 
or  any  other  evidence  of  increased  action  in  the  vessels  of  the  conjunc- 
tiva or  sclerotic,  should  meet  with  prompt  attention  and  careful  treat- 
ment, by  which  the  integrity  of  the  organ  may  be  in  most  instances 
restored,  and,  at  all  events,  useful  vision  preserved. 

"  The  organ  should  be  perfectly  rested,  and  kept  from  exposure  to 
bright  light.  Counter  irritation,  by  means  of  blister  or  tartar  emetic 
ointment,  should  be  created  upon  the  forehead  or  temple ;  the  diet  should 
be  adapted  to  the  power  of  the  patient,  but  he  should  avoid  stimulating 
food  or  drink,  (beyond  that  which  habit  may  have  rendered  necessary,) 
and  such  matter  as  is  not  easy  of  digestion,  or  is  incompatible  with  the 
medicine  employed. 

u  Medicinal  treatment  should  first  be  directed  to  correct  errors  in 
secretion,  and  restore  the  disordered  functions,  the  accomplishment  of 
which  is  frequently  sufficient  to  subdue  the  ocular  disease  ;  but  should 
the  vision  continue  disturbed,  the  alterative  mercurial  course  should  be 
adopted  and  the  local  remedies  continued.  It  is  very  rarely  necessary 
to  produce  mercurial  action  in  the  system." 

He  directs  that  blood  should  always  be  taken  away  in  moderation,  and 
only  in  sufficient  quantity  to  relieve  congestion,  but  not  to  nffect  the  general 
circulation;  that  in  "  many  cases,  when  the  disease  is  apparently  acute,  but 

*  P.  90. 


360  HUMAN    BRAIN. 

the  power  feeble,  the  loss  of  blood  aggravates  rather  than  benefits  the  affec- 
tion; this  1  have  observed  most  frequently  in  young  and  delicate  females. 
I  have  known  the  continuance  of  depletory  treatment  prove  most  injurious 
in  augmenting  the  morbid  action  and  hastening  disorganizing  process ." 

"  Unfortunately,  as  relief  frequently  follows  the  local  abstraction  of 
blood,  the  patient  in  every  fresh  attack  or  relapse  is  desirous  of  resorting 
to  the  same  treatment  again,  and  the  medical  attendant,  unacquainted 
with  its  injurious  effects,  readily  adopts  it;  the  relief  is,  however,  of 
short  duration,  and  this  burst  of  acute  symptoms  in  a  few  days  occurs. 
The  same  remedies  are  again  resorted  to  with  similar  effect,  but  the 
patient  is  further  reduced  in  power,  and  the  local  disease  has  made  some 
progress  in  disorganization.  Under  continuance  of  this  treatment  the 
patient  suffers  from  repeated  attacks  of  the  acute  kind,  each  of  which 
produces  an  increase  in  the  amaurosis,  and  eventually  vision  is  com- 
pletely destroyed,  while  at  the  same  time  the  general  health  is  materially 
deranged,  if  not  permanently  injured.  I  have  seen  several  very  dis- 
tressing cases  of  permanent  araaurosis  resulting  from  such  treatment ; 
and  I  have  also  known  many  instances  in  which  the  disease  has  been 
arrested  and  vision  preserved,  by  raising  and  maintaining  the  general 
power,  and  pursuing  the  medical  treatment  which  I  have  recommended, 
after  many  weeks  of  depletion  had  failed  to  produce  the  desired  effect." 

The  following  case  shows  the  value  of  this  plan  of  treatment  in  chro- 
nic meningitis  with  some  serous  effusion  : — 

Case  50. — A  lady,  aged  48,  a  married  woman,  but  without  any  children,  consulted  me  on 
the  8th  of  December,  1841,  for  drooping  of  the  right  eyelid  and  violent  pain  in  the  head. 
The  right  eyelid  droops  over  the  eyeball,  and  she  can  only  raise  it  half  way.  The  left  she 
has  complete  command  over.  There  is  a  quivering  motion  in  both  eyelids  and  eyeballs. 
When  she  closes  the  left  eye,  and  attempts  to  look  at  anything  with  the  right,  she  finds  her 
vision  very  imperfect  and  misty. 

She  complains  of  a  shooting,  pricking  pain  in  the  ball  of  the  right  eye,  with  a  feeling  of 
great  pressure  and  pain  on  the  left  side  of  the  head  and  face. 

She  says  she  sometimes  has  feelings  as  if  she  was  not  right  in  her  mind,  as  if  she  were 
going  delirious.  These  feelings  existed  previous  to  the  eye  being  affected.  Her  countenance 
is  rather  wild  and  anxious ;  the  eyes  staring  and  unnatural. 

She  complains  of  sensations  in  the  body  and  extremities,  which  she  calls  "live  blood,"  or 
"  pins  and  needles,"  as  if  there  was  something  fluttering  underneath  the  skin ;  sometimes  the 
right  eyeball  flutters  so  violently  that  it  feels  to  her  as  if  it  would  jump  out  of  her  head. 
The  right  arm  and  leg  sometimes  are  numb,  but  the  left  never  feels  so 

She  passes,  per  anum,  from  piles,  nearly  a  pint  of  blood  during  the  week,  which  she  con- 
siders gives  great  relief  in  the  head. 

I  found,  on  inquiry,  that  she  had  been  much  harassed  latterly,  and  suffered  much  anxiety 
of  mind. 

About  six  years  ago  she  had  a  bad  miscarriage,  since  which  the  womb  has  been  displaced, 
and  it  has  become  hard  and  shrunken,  and  prevented  all  connection  for  two  years.  She  has 
only  menstruated  once  during  the  last  two  years,  and  that  occurred  about  two  months  ago, 
and  she  felt  relieved  by  their  appearance.  Pulse  quick  and  irritable;  tongue  rather  pale, 
but  not  furred  ;  appetite  pretty  good  ;  sleeps  tolerably ;  feels  very  weak. 

Ordered  Hyd.  c.  Greta  gr.  ij.  nocte  maneque.  Emp.  Lyttse  fronti. 

After  using  the  mercury  in  doses  varying  according  to  its  effect,  and  never  so  as  to  sali- 
vate, with  various  counter-irritants,  issues,  &c.,at  the  same  time  supporting  the  general  health 
for  two  months  and  a  half,  the  paralysis  of  the  eyelid  was  entirely  cured,  and  the  pain  in 
the  head  left  her,  and,  as  she  felt  nearly  well,  she  left  off  her  medicine,  and  I  lost  sight  of  her 
for  above  two  months,  after  which  time  she  came  to  me  again. 

Her  countenance  is  worse;  the  right  eyelid  again  droops.  She  says  that  all  her  sufferings 
are  returned  as  bad  as  ever,  though  her  general  health  has  improved.  The  pain  at  the  back 
of  the  head  is  most  violent,  and  the  burning  sensation  at  the  top  of  the  neck  so  severe  that  she 
can  scarcely  contain  herself;  at  times  something  seems  to  pass  over  the  eyes  so  as  to  make 
her  blind.  Sometimes  the  sensations  are  so  horrible  that  she  feels  as  if  she  were  going  mad. 


TREATMENT    OF    INFLAMMATION    OF    THE    BRAIN.  361 

She  has  some  loss  of  power  on  the  right  side,  across  the  right  leg — it  feels  numb  and  heavy. 
Moral  causes  appear  to  have  produced  this  relapse,  though  she  says  that  soon  after  the  mouth 
became  well  from  the  mercury,  she  began  to  feel  uncomfortable.  This  time  I  was  obliged 
to  cup  her  three  or  four  times,  as  well  as  employ  mercury  in  full  doses.  She  came  under 
my  care,  on  this  occasion,  on  the  13th  of  April,  and  it  was  not  till  the  22d  of  June,  that  I 
could  report  any  decided  improvement;  by  this  time  she  was  able  to  walk  pretty  well,  her 
head  felt  easy,  and  she  says  she  can  now  use  her  reason. 

I  continued  the  mercury  for  four  months,  at  the  end  of  which  time  she  was  quite  well. 
Her  sight  was  quite  restored;  no  f>ain  in  her  head;  feels  strong  and  hearty;  spirits  good; 
mind  equable  and  placid.  Her  countenance  is  entirely  changed  ;  instead  of  a  staring,  wild, 
unnatural  expression,  she  looks  composed  and  comfortable.  She  expresses  herself  grateful 
for  her  recovery. 

I  have  been  gratified  in  finding  the  following  observations  on  the  use 
of  mercury  in  such  cases  from  the  pen  of  that  admirable  surgeon,  the 
late  Mr.  Colles,*  of  Dublin,  whose  work  on  the  treatment  of  syphilis  is 
one  of  the  best  in  the  English  language. 

"I  now  merely  wish  to  report  the  result  of  my  own  experience,  as  to 
the  efficacy  of  mercury  in  some  classes  of  disease,  in  which,  as  far  as  I 
know,  it  has  hitherto  been  but  seldom,  and  even  then  but  sparingly, 
employed.  I  allude  to  certain  derangements  of  the  brain  and  nervous 
system,  sometimes  accompanied  with  more  or  less  of  paralysis  of  the 
voluntary  muscles.  In  these  diseases  I  consider  mercury,  when  actively, 
and  at  the  same  time  judiciously,  administered,  to  be  a  most  invaluable 
medicine. 

"  This  position,  I  think,  I  can  best  establish  by  a  brief  statement  of 
a  few  cases,  which  I  have  selected  out  of  several  that  have  fallen  under 
my  own  immediate  observation." 

Colles  gives  eight  cases,  all  of  which  are  interesting  and  instructive, 
but  I  must  refrain  from  quoting  more  than  one.  This  I  have  selected 
because  it  is  of  that  class  which  I  believe  ultimately  terminates  in  mental 
imbecility. 

Case  51.— Oct.  3d,  1836.— Mrs.  B.,  of  Rathmines,  set.  50.  For  nearly  the  two  last  years, 
this  woman  has  suffered  many  severe  family  afflictions,  and  considerable  loss  of  property, 
in  consequence  of  which,  as  she  thinks,  she  has  become  subject  to  what  she  terms  "great  con- 
fusion in  the  back  of  the  head,"  which  of  late  has  extended  to  the  right  side  of  the  head  also. 
She  has  latterly  avoided  all  society,  and  has  sought  for  solitude.  At  the  same  time  she  ob- 
served a  failure  of  memory,  which,  within  the  last  six  weeks,  has  increased  considerably, 
so  that  now  she  cannot  find  words  to  express  her  ideas.  If  she  chance  to  lay  a  key  or  any- 
thing out  of  her  hand,  she  cannot,  in  a  minute  after,  recollect  where  she  had  placed  it.  She 
is  unable  to  read,  as  the  attempt  instantly  brings  on  the  "confusion  in  the  head  ;  if  she  attempt 
to  recollect  anything,  it  all  ends  in  the  same  confusion ;  nor  can  she  even  attempt  to  do  any 
needlework,  as  this  would  be  followed  by  the  same  distressing  sensation.  Her  temper  has 
become  extremely  peevish  and  irritable ;  she  suffers  from  a  constant  sickness  of  stomach  like 
sea-sickness.  When  she  attempts  to  walk,  she  staggers,  as  she  says,  in  consequence  of  a 
dizziness  in  her  head,  yet  she  can  walk  in  a  dark  room ;  nor  is  she  alarmed  by  looking  down 
from  a  height.  Her  appetite  is  good;  the  bowels  are  very  costive;  she  sleeps  very  heavily; 
there  is  no  emaciation;  pulse  96.  I  determined,  in  this  case,  to  try  the  effect  of  ptyalism  ; 
and  having  prescribed  a  strong  purging  draught,  directed  calomel  gr.  iij.  bis  in  die. 

Oct.  7th. — She  has  had  a  slight  attack  of  mercurial  dysentery  yesterday,  with  some  sore- 
ness of  the  mouth  and  gums;  she  describes  what  she  terms  the  confusion  in  the  back  of  the 
head  as  being  much  less;  there  is  a  decided  improvement  in  her  memory;  she  can  now 
much  more  readily  and  more  constantly  find  words  to  express  her  ideas.  She  has  some 
sickness  of  stomach,  but  different  from  that  kind  of  sickness  she  has  so  long  suffered. 

Oct.  10th. — She  can  now  read  and  attend  to  figures,  and  can  even  cast  up  an  account, 
which  she  could  not  previously  attempt  to  do ;  but  still  she  feels  she  would  become  confused 


*  On  the  Use  of  Mercury  in  Affections  of  the  Nervous  System.    By  Abraham  Colles,  1837, 
p.  328. 


362  HUMAN    BRAIN. 

if  she  attended  to  them  beyond  a  very  short  time.     Habeat  Haust.  c.  Quinae.  Sulph.  gr.  ij. 
bis  in  die. 

Oct.  18th. — Whenever  she  stoops  or  turns  about  her  head  suddenly,  she  feels  a  sense  of 
confusion,  and  then  a  pain  in  the  head.  Her  sleep  is  less  heavy,  and  much  more  refreshing  ; 
she  can  now  read  as  much  as  twenty  pages  of  a  book  at  once.  She  takes  an  interest  in  it, 
and  can  recollect  what  she  has  read.  Says  she  feels  as  if  some  great  weight  had  been  lifted 
off  her ;  ptyalism  was  still  maintained  by  occasional  doses  of  mercury.  Habeat  Urigt.  Ant. 
Tart.  Vertici  capitis. 

Oct.  24th. — Pustules  have  been  produced  by  eleven  applications  of  ointment.  She  can 
now  stoop,  and  look  up  suddenly,  without  any  unpleasant  sensations;  her  memory  and  spirits 
are  improving;  she  can  now  attend  to  her  household  affairs,  and  can  recollect  what  she  has 
to  do. 

Nov.  3d. — She  now  reads  with  interest,  and  recollects  what  she  has  read  a  week  before ; 
her  temper  is  still  very  irritable,  especially  if  hurried;  her  spirits  are  much  better  in  the 
latter  part  of  the  day — in  the  morning  she  feels  very  nervous ;  jolting  of  the  car  makes  her 
head  still  feel  a  little  giddy. 

Nov.  13th. — She  feels  much  improved  in  every  respect;  she  becomes  fidgetty  and  uneasy 
at  10  P.M.  before  she  goes  to  bed; — this  is  the  principal  nervous  uneasiness  she  now  experi- 
ences. She  feels  her  temper  much  improved  since  the  scalp  has  healed. 

Nov.  16th. — She  walked  from  Rathmines  to  my  house,  upwards  of  a  mile,  this  day,  and 
feels  no  inconvenience  except  a  very  slight  giddiness.  Her  sleep  is  now  refreshing  and 
natural,  her  temper  much  improved ;  she  does  not  now  suffer  from  confusion  when  she  is 
hurried. 

I  observed,  that  during  the  entire  treatment,  her  bowels  required  very  active  aperients, 
the  uneasy  feelings  in  her  head  uniformly  becoming  aggravated  by  costiveness. 

Dr.  Alison,*  in  speaking  of  the  symptoms  which  mark  those  "  cases 
of  active  inflammation  within  the  cranium,  such  as  bear  evacuations 
best,  and  are  most  generally  and  decidedly  benefitted  by  them  when  used 
early  and  carried  to  a  due  degree,"  after  mentioning  the  ordinary  symp- 
toms, such  as  pain,  impatience  of  light  and  sound,  sickness  and  vomit- 
ing, adds,  "  great  aggravation  of  the  uneasy  feelings  in  assuming  the 
erect  posture."  As  a  general  rule,  I  find  the  contrary:  that  the  recum- 
bent posture  is  the  most  comfortable  in  anaemia,  the  erect  in  hypersemia. 
It  is  possible  that  all  he  means  is,  that  every  kind  of  motion  is  painful ; 
and  there  I  agree  with  him,  but  not  that  it  is  limited  to  the  inflammatory 
affections.  He  agrees  with  most  pathologists  in  objecting  to  the  use  of 
opium  in  these  affections.  He  is  strongly  in  favor  of  general  bleeding 
in  all  well-marked  cases  of  inflammation  of  the  brain  and  its  membranes. 
He  says  :  "  The  bleeding  should  be  general  and  local,  but  the  former  is 
by  far  the  most  important ;  and  it  may  be  laid  down  as  a  general  rule,  to 
trust  no  case  to  the  local  bleeding  only  beyond  the  age  of  five  years. 
There  are  some  cases,  particularly  in  adults,  in  which  the  inflammation 
lasts  very  long,  or  returns  very  frequently,  and  ultimately  abates  com- 
pletely, under  repeated  local  or  even  general  bleeding,  without  stupor, 
delirium,  or  spasms,  ever  supervening ;  while  in  others,  those  results  of 
the  disease  show  themselves  within  a  few  days."f 

Dr.  H.  Holland  makes  some  excellent  observations  on  the  use  of 
mercury,  particularly  the  bichloride,  in  affections  of  the  nervous  system, 
especially  supporting  my  opinion  of  the  value  of  its  continuance.  He 
says  *4  "  Perseverance  in  the  use  of  bichloride  of  mercury  is  of  singular 
avail  in  certain  cerebral  or  spinal  disorders — to  obtain  the  full  benefit, 
we  must  be  patient  as  well  as  decided  in  its  use."  He  refers  to  one 
very  interesting  case. 

*  Outlines  of  Pathology,  &c.,  1844.  t  P-  344>  °P-  cit- 

J  P.  250,  op.  cit. 


APOPLEXY.  363 

Treatment.  —  Recapitulation.  —  In  the  treatment  of  all  inflammatory 
affections  of  the  brain,  the  following  broad  principles  must  always  be 
attended  to: — 

1st.  There  is  no  time  to  be  lost — even  minutes  are  of  value. 

2dly.  That  inflammation  of  the  brain  is  a  depressing  disease,  and 
that,  as  a  general  rule,  general  blood-letting  is  not  often  admissible. 

3dly.  That,  though  general  blood-letting  may  sometimes  be  attended 
with  benefit  at  the  time,  the  good  derived  from  it  is  seldom  permanent. 

4thly.  That  local  blood-letting,  by  leeches  and  cupping,  is  generally 
useful,  and  especially  in  cases  of  insomnolence,  arising  from  abnormal 
action  of  the  brain. 

5thly.  In  cases  of  insanity,  where  opium  has  failed  to  produce  sleep, 
leeches  and  cold  applications  frequently  will ;  and  if  they  do,  it  is  strong 
evidence  that  the  excitement  arises  from  hyperasmia,  and  not  from  ana> 
mia,  as  in  that  of  delirium  tremens. 

6thly.  That  aconite  and  digitalis  are  the  best  sedatives,  especially 
when  combined  with  mercury. 

7thly.  When  it  is  advisable  to  salivate  rapidly,  raise  the  cuticle  by 
boiling  water,  or  a  similar  escharotic,  and  dress  the  surface  with  the 
strong  mercurial  ointment. 

Sthly.  Always  commence  the  treatment  with  a  brisk  mercurial  pur- 
gative. 

9thly.  Soothe  the  patient's  feelings  in  every  way. 

lOthly  Never  leave  anything  that  is  disagreeable  to  the  patient  to  be 
done  by  a  nurse  or  attendant,  such  as  the  application  of  leeches,  &c., 
but  persuade  him  to  have  them  applied. 

llthly.  Never  lose  your  patience  in  the  treatment  of  a  chronic  case, 
or  try  to  hasten  the  cure  by  increasing  the  doses. 

12thly.  When  it  is  considered  necessary  to  continue  the  use  of  mer- 
cury for  a  lengthened  period,  combine  tonics  with  it. 

Apoplexy. — The  term  is  derived  from  the  Greek  word  artojt^lw,  to 
strike;  hence  the  common  appellation,  an  apoplectic  stroke,  or  a  stroke 
of  the  palsy. 

Apoplexy,  Jong  as  this  term  has  been  familiar  to  the  profession,  still 
conveys  a  very  indefinite  meaning.  Some  authors  use  it  to  distinguish 
a  particular  class  of  symptoms  and  effects  of  disease ;  others  to  desig- 
nate the  pathological  condition  which  gives  rise  to  those  symptoms. 

I  thinkthat.it  is  applied  too  generally  to  the  effects  of  disease,  instead 
of  the  cause.  The  classification  of  diseases  of  the  brain  which  I  have 
adopted  is  founded  on  pathology*,  not  on  symptomatology.  I  propose 
using  it  to  designate  pressure  on  the  brain,  or  encephalon,  produced  by 
extravasation  of  blood  or  serum,  or  by  distension  of  the  vessels  without 
extravasation,  such  extravasation  not  being  the  result  of  direct  violence, 
as  a  blow  upon  the  head.  Wherever  I  employ  the  term  apoplexy,  I  use 
it  as  synonymous  with  cerebral  pressure,  and  I  believe  that  all  its  varieties 
depend  on  the  amount  of  the  effusion  and  the  part  of  encephalon  injured. 

This  view  of  the  subject  will  be  exposed  more  clearly  as  we  proceed. 

Apoplexy,  in  its  most  aggravated  form,  is  an  awful  disease  to  suffer 
from,  to  witness,  or  administer  to. 

A  man,  in  apparently  good  health,  suddenly  falls  down  deprived  of 


364  HUMAN    BRAIN. 

all  his  senses,  wholly  unconscious  of  surrounding  objects.  The  coun- 
tenance livid,  the  vessels  of  the  face  and  head  turgid  with  blood,  the 
breathing  stertorous,  slow,  and  laboring;  the  limbs  lie  powerless;  the 
pulse  is  full,  slow,  and  intermittent:  from  this  state  he  never  rallies, 
sinks  without  any  change,  and  dies  in  the  course  of  forty-eight  hours. 
His  brain,  when  examined  after  death,  is  found  to  have  been  more  or 
less  torn  and  destroyed  by  extravasated  blood. 

This  may  be  considered  as  a  typical  case  of  apoplexy,  but  this  de- 
scription of  it  will  no  more  include  all  the  varieties  of  this  disease,  all 
the  aberrant  forms  of  the  complaint,  if  we  may  so  speak,  than  the  de- 
scription of  the  characteristics  of  the  eagle  would  include  that  of  the 
whole  class  of  rapacious  birds. 

It  is  typical,  because  the  extravasation  is  so  severe  that  all  the  effects 
of  extravasation  are  produced — all  the  centres  of  nervous  power  with- 
in the  cranium  are  affected.  The  aberrant  forms  are  merely  slighter 
effects,  from  a  slighter  but  a  common  cause. 

It  is  said  that  apoplexy  may  be  confounded  with  syncope,  ordinary 
sleep,  and  epilepsy;  but  when  we  consider  the  above  phenomena  which, 
in  a  greater  or  less  degree,  always  attend  the  apoplectic  seizure,  we  must 
allow  that  they  are  peculiar  to  the  disease. 

In  such  a  case  as  the  above  it  could  not  be  mistaken  for  syncope,  for 
the  patient  is  not  pale  and  cold,  the  pulse  is  not  feeble.  It  could  not 
be  mistaken  for  sleep — it  occurred  too  suddenly,  and  the  patient  could 
not  be  awakened.  It  could  not  be  mistaken  for  epilepsy,  for  there  was 
no  cry  and  no  convulsions. 

But  there  are  some  cases  of  apoplexy  which  might  be  mistaken  for 
syncope,  and  others  which  might  be  mistaken  for  epilepsy. 

Abercrombie  arranges  apoplexy  under  three  forms  of  apoplectic  attack, 
and  very  admirable  are  his  descriptions.  The  first  are  those  which  are 
immediately  and  primarily  apoplectic,  using  the  term  as  synonymous 
with  coma  ;  the  second  are  those  which  begin  with  a  sudden  attack  of 
headache,  and  pass  gradually  into  apoplexy;  and  the  third  are  those 
which  are  characterized  by  palsy  and  loss  of  speech,  without  coma  : 
classifying  them  according  to  the  symptoms.  If  we  reverse  the  order, 
we  find  that  the  first  form  depends  upon  such  a  sudden  and  extensive 
effusion  into  the  hemispheres,  that  the  powers  of  the  hemispherical  gan- 
glion are  at  once  arrested,  as  in  a  case  of  severe  concussion  of  the  brain. 
The  second  form  of  apoplexy,  which  might  be  mistaken  for  syncope,  is 
thus  described  by  Abercrombie: — 

"The  patient  becomes  pale,  sick,  and  faint,  generally  vomits,  and 
frequently,  though  not  always,  falls  down  in  a  state  resembling  syncope  ; 
the  face  pale,  the  body  cold,  and  the  pulse  very  feeble  :  this  sometimes 
accompanied  by  slight  convulsion.  In  other  cases,  he  does  not  fall 
down  ;  the  sudden  attacks  of  pain  being  only  accompanied  by  slight 
and  transient  loss  of  recollection.  In  both  cases  he  generally  recovers 
in  a  few  minutes,  from  the  first  effects  of  the  attack,  is  quite  sensible 
and  able  to  walk,  but  continues  to  complain  of  headache  after  a  certain 
interval,  which  may  vary  from  a  few  minutes  to  several  hours;  he  be- 
comes oppressed,  forgetful  and  incoherent,  and  then  sinks  into  coma,  from 
which  he  never  recovers.  In  some  cases  paralysis  of  one  side  occurs; 


APOPLEXY.  365 

but  in  others,  and  I  think  the  greater  proportion  o-f  this  class,  no  para- 
lysis is  observed. "* 

This  form  will  be  pathologically  described  as  menirvgeal  apoplexy. 
The  effusion  taking  place  on  the  surface  of  the  vertex  of  the  brain,  and 
giving  rise  to  headache,  the  effusion  taking  place  in  such  small  quantity, 
and  so  slowly  that,  the  powers  of  the  sensorium  not  being  at  once  anni- 
hilated, the  patient  is  cognizant  of  pain;  the  effusion  continuing,  till  at 
last  all  the  cerebral  ganglia  are  compressed,  and  the  patient  dies  coma- 
tose. Dr.  Abercrombie  remarks  on  the  similarity  of  these  cases  to  those 
extravasations  from  external  injury,  where  the  patient  recovers  from  the 
first  effect  of  such  effusion,  and  is  even  able  to  walk  home.  The  fol- 
lowing illustrates  this  in  a  striking  way  :•— 

Case  52. — Laceration  of  brain,  from  a  blow  on  the  head  without  fracture  of  the  skull. — 
May  7th,  1845. — I  was  this  day,  at  nine  o'clock,  A.  M.T  called  in  by  Mr.  Maybury.  of  Little 
Tower  Street,  to  see  Mr.  T.  F.  C.,  Love  Lane,  Eastcheap,  who  was  suffering  from  injury 
to  the  head. 

He  was  about  fifty  years  of  age,  and,  as  I  learned  from  his  daughter,  generally  of  temper- 
ate habits.  It  appeared  that,  between  five  and  six  in  the  afternoon,  he  had  been  struck  about 
the  face  and  chest  by  another  man,  and  that  in  falling  he  hit  the  back  of  his  head  against  the 
pavement;  he  was  rendered  insensible  by  the  fall,  but  became  conscious  on  arriving  at  the 
London  Hospital,  whither  he  was  conveyed.  His  wound  was  dressed,  and  the  dresser  ad- 
vised him  to  remain  at  the  Hospital;  he,  however,  refused,  saying  that  his  wife  would  be 
rendered  anxious  by  his  absence.  From  Mr.  Maybury  I  learned  the  following  particulars, 
viz ,  that  he  was  sent  for  on  the  same  evening,  and,  on  arriving  at  the  house,  found  C.  sit- 
ting in  a  chair  near  the  fire,  relating  with  all  his  usual  reason  the  circumstances  which  led 
to  the  fall  above  mentioned.  Mr.  M.'s  attention  was  immediately  called  to  the  profuse  haa- 
morrhage  issuing  from  the  dressings  on  the  head,  on  the  removal  of  which  dressings,  two 
large  incised  wounds  on  the  left  side  of  the  occipital  bone  were  exposed.  These  wounds 
penetrated  to  the  cranium,  and  were  distant  from  each  other  about  a  quarter  of  an  inch,  each 
being  an  inch  in  length.  Several  small  arteries  were  pouring  out  blood  profusely.  This 
Weeding  being  suppressed,  the  wounds  were  dressed  simply  with  lint  soaked  in  cold  water. 
The  patient  was  put  to  bed,  when  he  was  attacked  with  rigors.  He  was  ordered  a  mixture 
of  aromatic  spirits  of  ammonia  ;  camphor  mixture  and  spirits  of  lavender.  On  the  following 
morning,  the  7th,  Mr.  Maybury  called,  and  found  him  laboring  under  difficult  and  stertorous 
breathing,  and  presenting  all  the  worst  symptoms  of  compression  ;  the  pupils  remaining  fixed 
beibre  the  glaring  light  of  a  candle,  the  right  dilated,  the  left  contracted.  These  symptoms, 
preceded  by  a  short  attack  of  shivering,  commenced  immediately  after  Mr.  Maybury 's  de- 
parture on  the  foregoing  evening.  Mr.  Maybury  bled  him,  and  immediately  afterwards 
called  upon  me.  I  found  the  patient  breathing  stertorously,  and  with  great  difficulty;  in 
fact,  he  appeared  almost  moribund ;  his  pulse  varied,  never  full  or  strong,  but  every  now 
and  then  gradually  stopping  altogether,  and  then  going  on  again;  it  was  not  merely  inter- 
mittent. Both  pupils  were  fixed,  the  left  contracted,  the  right  dilated.  There  was  a  small 
wound,  about  one  inch  in  length,  behind  the  left  ear.  I  put  my  little  finger  into  it,  but  could 
not  feel  any  fracture.  This  operation  was  evidently  felt  by  him,  for  he  moved  his  head 
about,  and  his  stertorous  breathing  was  altered,  so  as  almost  to  amount  to  a  groan.  I  tried 
if  he  could  swallow  a  little  water;  but  he  was  nearly  suffocated  by  the  attempt. 

I  ordered  a  turpentine  enema  !|j.  to  the  Ibj.  A  blister  to  the  side  of  the  neck,  to  be 
dressed  with  mercurial  ointment;  and  we  agreed  to  see  him  again  at  about  one,  if  he  was 
alive.  His  head  was  shaved,  and  a  cold  spirituous  lotion  kept  constantly  applied.  Mr.  May- 
bury  visited  him  several  times  during  the  day:  he  continued  to  grow  worse,  and  died  about 
five  o'clock  the  following  morning. 

We  examined  the  head,  and  lound  the  following  appearances,  viz. — 

Extravasation  under  'the  scalp  on  the  left  side  extending  to  and  through  the  left  temporal 
muscle.  Laceration  of  the  under  surface  of  the  middle  lobe  of  the  brain  on  the  right,  with 
coagulated  bloo  1  on  the  same  side,  amounting  in  quantity  to  about  three  or  four  ourn-e«,  be- 
tween the  dura  mater  and  the  brain.  No  fracture  of  the  skull.  Strong  adhesions  of  the 
dura  mater  to  the  cranium.  Brain  otherwise  healthy. 

In  this  case  death  endued  from  pressure,  as  in  apoplexy,  though  the  active  external  hae- 
morrhage delayed  the  fatal  event. 


*  Op.  cit^  p.  204. 


HUMAN   BRAIN. 

The  pallor  and  faintness  which  attend  the  class  of  apoplectic  cases 
before  spoken  of,  and  which  appear  to  remove  them  from  true  apoplexy, 
arise  from  the  sudden  loss  of  blood  occurring  from  the  vessels  of  an  im- 
portant organ.  It  is  well  known  that  a  very  small  loss  of  blood  from 
the  vessels  of  the  intestinal  canal,  the  lungs,  and  other  viscera,  will 
cause  great  vital  depression,  while  a  much  larger  quantity  may  be  re- 
moved from  the  extremities  without  the  constitution  taking  the  alarm. 
And  thus  it  is  with  the  brain,  if  its  normal  sensibility  is  not  interrupted 
by  the  pressure  of  the  extravasated  blood.  Again  ;  the  reason  that  this 
form  of  apoplexy  differs  from  the  typical  form,  in  absence  of  congestion 
of  those  vessels  of  the  head  which  are  apparent  to  the  eye,  as  shown  by 
the  red  or  purple  countenance,  is,  that  the  proximate  cause  of  the  ex- 
travasation is  not  over-distension  of  the  blood-vessels  of  the  brain,  but 
disease  in  their  coats,  which  then  suddenly  break  under  the  heart's 
action.  If  the  patient  recover  his  senses  quickly,  it  is  because  the 
opening  is  very  small,  and  the  quantity  extravasated  in  accordance  with 
the  aperture. 

Abercrombie  observes,  and  I  believe  truly,  that  these  cases  are  gene- 
rally fatal.  This  may  be  thus  explained.  We  cannot  by  any  remedial 
measures  with  which  we  are  at  present  acquainted,  alter  this  diseased 
condition  of  the  coats  of  the  blood-vessels,  and  it  is  seldom,  if  ever,  that 
a  rent  in  a  diseased  vessel  is  closed  by  that  adhesive  action  by  which 
nature  repairs  similar  lesions  in  healthier  tissues.  We  can  moderate, 
for  a  time  at  least,  the  inordinate  action  of  a  diseased  heart — we  can 
relieve  a  vascular  system,  unnaturally  distended  with  blood — we  can 
prevent  mental  and  cerebral  excitement  by  judicious  moral  treatment — 
we  can  promote  the  absorption  of  extravasated  blood,  and  thus  it  is  that 
all  cases  of  apoplexy  are  not  fatal,  and  not  irremediable  ;  but  in  these 
cases  of  pallid,  fainting  apoplexy,  such  measures  are  of  little  use.  These 
observations  touching  the  treatment  of  apoplexy  may  appear  premature, 
but  I  have  thought  them  necessary  in  order  to  account  for  such  different 
symptoms  arising  from  pathological  states  so  nearly  similar  and  requiring 
nearly  similar  treatment. 

In  the  third  class  the  effusion  takes  place  near  the  base  of  the  brain, 
or  in  the  motor  tract  near  the  anterior  and  posterior  cerebral  ganglia, 
and  is  so  limited  that  it  does  not  affect  either  the  hemispherical — the 
intellectual  ganglia — or  the  respiratory  ganglia;  and  hence  the  absence 
of  coma  and  stertor. 

This  class  includes  many  cases  which  will  be  considered  seriatim 
when  we  investigate  the  peculiar  effect  of  effusion  according  to  the 
portion  of  the  encephalon  injured. 

Apoplexy  may  be  again  divided  into  three  groups,  in  accordance  with 
the  matter  which  produces  the  pressure  from  which  the  apoplectic  symp- 
toms result — namely,  extravasated  blood,  sanguinous  apoplexy;  extra- 
vasated serum,  serous  apoplexy;  abnormally  distended  blood-vessels, 
simple  apoplexy.  In  these  latter  cases  there  are  no  post-mortem  appear- 
ances. 

There  is  a  state  of  brain  that  may  be  advantageously  adverted  to  here 
which  closely  resembles  the  apoplectic  condition,  but  which  requires  a 
very  different  line  of  treatment.  I  cannot  pretend  to  say  exactly  what 


APOPLEXY.  367 

the  pathological  condition  is — but  not  anaemia ;  I  suspect  it  is  one  of 
very  partial  congestion, — limited,  simple  apoplexy.  The  following  case 
illustrates  it : — 

Case  53. — 1847. — I  was  called  to  visit  a  gentleman  in  the  city,  who  had  been  suddenly 
attacked  with  paralysis.  I  found  him  sitting  on  a  stool  in  his  office,  perfectly  conscious,  but 
unable  to  articulate  a  word ;  he  endeavored  by  signs  to  call  my  attention  to  his  having  lost 
the  use  of  the  whole  of  the  right  side  of  the  body  and  extremities.  On  asking  him  his  age, 
he  made  signs  for  pen  and  ink  and  paper,  and  wrote  with  the  left  hand,  tolerably  legibly, 
"49  or  50,  also  a  bad  cough."  I  found  his  pulse  very  variable  in  both  strength  and  quick- 
ness, but  not  positively  intermittent,  nor  laboring  or  jerking,  soft  and  compressible.  On  my 
calling  for  a  basin,  he  became  excessively  agitated,  which  I  afterwards  found  arose  from 
his  being  afraid  I  was  going  to  bleed  him.  As  soon  as  I  got  the  basin,  I  poured  cold  water 
over  his  head  with  a  jug,  which  operation  I  had  scarcely  commenced  before  he  spoke  quite 
distinctly,  saying  I  am  all  right  again  :  he  then  told  me  that  the  first  uncomfortable  symp- 
tom he  had,  took  place  about  an  hour  previous ;  he  wanted  to  put  "clown  on  paper  108,  but 
found  his  hand  fail  him,  and  he  could  not  write  more  than  10 :  this  annoyed  him,  and  he  made 
some  excuse ;  the  uncomfortable  sensations  were  sufficient  to  frighten  him,  and  induce  him 
to  send  off  immediately  for  medical  assistance,  but  they  passed  off  so  quickly  that  he  soon  sent 
another  messenger  to  say  he  was  quite  well,  and  left  his  counting-house  to  return  home  to 
Greenwich ;  but  he  had  not  proceeded  far  before  they  all  returned,  though  to  a  much  greater 
extent,  reducing  him  to  the  state  in  which  I  found  him. 

Previous  history. — A  man  of  highly  nervous  temperament,  exceedingly  active  in  business, 
in  which  he  has  been  a  good  deal  harassed  lately,  leaving  him  scarcely  any  time  for  his 
meals,  and  giving  him  a  great  deal  of  anxiety :  he  had  been  -repeatedly  warned  by  his  wife 
and  friends  that  if  he  did  not  pay  more  attention  to  his  health,  he  would  have  some  serious 
illness;  this  they  said  from  seeing  him  every  now  and  then  in  a  state  of  great  exhaustion  : 
he  had  also  been  suffering  lately  from  hooping-cough. 

It  was  very  clear  that  stimulants  were  the  only  things  indicated  here  in  the  first  in- 
stance. I  therefore  gave  him  a  small  quantity  of  brandy  and  water,  and  some  sal- volatile  : 
in  a  few  minutes  after  he  had  recovered  his  speech  he  recovered  the  whole  use  of  his  right 
side,  declaring  that  he  felt  perfectly  well,  and  determined  to  return  home ;  we  therefore  put 
his  things  on  and  sent  for  a  cab,  but  when  he  got  up  to  go  down  stairs,  he  said,  "  I  am  afraid 
I  am  going  to  be  ill  again,"  and  I  asked  him  why  he  thought  so :  he  answered,  because  I 
am  losing  the  power  over  my  hand  and  leg  ;  and  his  speech  began  to  falter ;  he  then  told 
me  where  he  wished  to  be  taken,  lest  in  a  few  minutes  he  should  not  be  able  to  speak.  I 
gave  him  some  more  sal-volatile  and  brandy  :  in  a  few  minutes  more,  all  these  unpleasant 
symptoms  had  again  passed  away,  and  we  were  enabled  to  proceed  safely  without  any  re- 
turn of  them,  to  his  own  house  at  Greenwich.  On  his  way  down  he  several  times  declared 
he  never  felt  better  in  his  life,  and  said  it  was  very  strange  he  should  have  been  so  ill  such 
a  short  time  before.  At  Greenwich,  I  left  him  in  the  hands  of  his  own  medical  man,  Mr. 
Watsford,  recommending  a  warm  bed,  hot  water  to  the  feet,  mustard  poultices  to  the  legs, 
and  a  mild  aperient. 

I  have  learnt  since  from  Mr.  Watsford,  under  whose  care  he  remained,  that  he  had  one  or 
two  threatenings  of  a  return  of  his  illness,  but  that  they  were  averted  by  the  same  general 
plan  of  treatment,  and  that  he  is  now  quite  recovered. 

The  predisposing  causes  of  apoplexy,  though  uncertain,  still  deserve 
consideration.  A  peculiar  conformation  may  be  mentioned  ;  a  full  florid 
countenance,  short  neck.  Advanced  age  is  also  a  predisposing  cause  of 
apoplexy.  Individuals  seem  to  inherit  from  their  ancestors  a  predispo- 
sition to  this  disease,  occasioned,  most  probably,  by  a  similar  morbid 
condition  of  the  coats  of  the  cerebral  vessels,  or  of  the  heart  and  its 
valves. 

Other  predisposing  causes  exist,  but  these  are  secondary,  being  de- 
pendent on  disease  of  other  organs,  as  organic  disease  of  the  heart  and 
arteries,  diseases  of  the  lungs,  sudden  changes  in  the  system,  cessation 
of  the  menses  or  drying  up  of  pus-secreting  surfaces.  Drunken  habits 
may  also  be  reckoned  as  a  predisposing  cause. 

The  profession  have  long  been  aware  of  the  concomitance  of  diseases 
of  the  heart  and  diseases  of  the  brain.  When  it  was  my  duty  to  conduct 


368  HUMAN    BRAIN. 

the  post-mortem  examinations  at  St.  Thomas's  Hospital,  I  scarcely  ever 
examined  a  case  of  apoplexy  without  finding  some  disease  of  the  heart 
and  arteries,  generally  hypertrophy  of  the  left  ventricle,  with  atheroma- 
tous  deposit  in  the  coats  of  the  vessels  of  the  brain;  and  of  course  I 
pointed  out  to  the  students  how  both  these  diseases  would  in  themselves 
and  unconnected,  facilitate  sanguineous  effusion;  the  first  giving  to  the 
forcing  pump  undue  power,  which  the  vessels  nearest  to  it  would  feel 
the  most,  and  the  second  making  that  tube  brittle,  which  in  a  state  of 
health  is  elastic,  though  firm.  I  was  therefore  surprised  to  find  from  Dr. 
Burrowes'  researches  that  so  many  writers  on  diseases  of  the  brain,  and 
among  the  number  Dr.  Abercrombie,  should  have  omitted  all  mention 
of  the  influence  of  diseases  of  the  heart  in  producing  cerebral  diseases. 
Dr.  Burrowes  says,*  uln  opposition  to  the  opinions  entertained  by  many 
respectable  authorities  that  the  quantity  of  blood  within  the  cranium  is 
at  all  times  nearly  the  same,  and  that  the  heart  does  not  influence  the 
cerebral  circulation,  ray  own  observations,  supported  by  facts  already 
detailed,  convince  me  that  in  many,  perhaps  the  majority  of  cases  of 
apoplexy  and  hemiplegia,  the  primary  disease  is  not  situated  within  the 
cranium. 

u  I  would  go  further,  and  affirm,  that  in  many  cerebral  affections  ap- 
parently depending  on  effusions  of  serum  or  blood,  there  is  no  further 
primary  disease  of  the  brain  than  there  is  of  the  cellular  tissue  in  ana- 
sarca,  or  of  the  peritoneum  in  ascites,  or  of  the  skin  in  purpura,  or  of 
the  stomach  in  ha3matemesis.  There  is,  indeed,  a  palpable  morbid  con- 
dition of  these  several  tissues  and  organs  where  the  effusion  or  ecchy- 
mosis  takes  place  ;  but  it  is  generally  dependent  upon  a  morbid  state  of 
some  other  viscus  which  generally  interferes  with  the  circulation  in  the 
parts  where  the  effusions  are  detected.  An  hypertrophied  left  ventricle, 
or  valvular  obstruction  in  the  heart,  will  lead  to  lesions  within  the  cra- 
nium, similar  to  those  observed  in  the  stomach  and  peritoneum  when 
there  is  obstruction  to  the  circulation  through  the  portal  veins  in  the 
liver. 

"  If  the  pathology  of  the  brain  in  apoplexy  and  hemiplegia  be  analo- 
gous to  that  of  other  organs  which  suffer  from  effusions  of  serum  and 
blood,  how  much  must  this  knowledge  improve  the  routine  treatment  of 
apoplexy,  which  has  so  extensively  prevailed. 

"Does  not  the  view  of  the  pathology  of  apoplexy  render  more  intelli- 
gible those  different  varieties  of  the  disease  which  are  described  by  an- 
cient writers,  although  they  could  not  account  for  the  differences?'7 

We  must  all,  I  think,  accord  with  Dr.  Burrowes  in  these  opinions. 
It  is  very  clear,  that  if  Abercrombie's  judgment  had  not  been  warped  by 
his  peculiar  views  regarding  the  cerebral  circulation,  he  would  have 
seen  more  distinctly  than  he  did  the  relation  between  the  various  cere- 
bral lesions,  and  their  vital  effects. 

As  a  general  observation,  attacks  of  apoplexy  are  apparently  sudden 
and  unexpected,  but  on  inquiry  we  frequently  find  that  the  subjects  of 
the  attack  have  been  indisposed  and  out  of  health  for  a  shorter  or  longer 
time ;  it  is,  therefore,  important  to  consider  the  premonitory  symptoms, 

Op.  cit.,  p.  124, 


APOPLEXY.  369 

-which,  if  not  attended  to,  would  usher  in  an  apoplectic  fit.  The  patient 
will  sometimes  exhibit  an  unusual  tendency  to  sleep,  will  sleep  long 
and  heavily,  with  laborious  breathing,  sometimes  almost  amounting  to 
stertor;  a  constant  dull  pain  in  the  head,  and  this,  when  the  patient  has 
not  been  previously  subject  to  headache,  should  put  us  on  our  guard. 

Vertigo,  or  swimming  in  the  head,  after  stooping  for  a  short  time,  the 
countenance  exhibiting  a  livid  hue,  the  veins  on  the  forehead  turgid, 
the  carotids  and  temporals  pulsating  forcibly.  Sometimes  there  is  tinnitus 
aurium,  partial  deafness  or  blindness ;  double  vision  is  also  a  common 
and  very  suspicious  symptom.  The  mental  faculties  are  more  or  less 
impaired,  memory  is  lost,  but  more  frequently  only  partially  so.  The 
most  common  terms  and  occurrences  are  forgotten,  while  the  memory  of 
uncommon  words  and  circumstances  is  perfect;  sometimes  one  word,  of 
a  totally  different  meaning,  is  substituted  for  another.  The  patient  ap- 
pears at  times  quite  imbecile,  temper  irritable;  at  other  times  he  remains 
in  an  apathetic  condition,  from  which  it  is  very  difficult  to  rouse  him. 
There  is  also  generally  a  tendency  to  paralysis,  which  exhibits  itself  in 
various  ways.  Ptosis  is  not  uncommon  as  a  precursory  symptom;  or  the 
patient  may  be  unable  to  articulate  his  words  from  partial  paralysis  of 
the  muscles  of  the  tongue.  Drawing  of  the  corner  of  the  mouth  from 
palsy  of  the  opposite  muscles,  an  unsteadiness  of  gait,  tripping  over 
slight  impediments,  are  one  and  all  occasionally  observed.  Frequent 
cramps  and  numbness  of  the  limbs,  toes,  or  fingers,  all  exhibit  a  tendency 
to  paralysis,  and  are  consequently  deserving  of  serious  consideration. 

Now  although  the  above  is  a  tolerably  correct  outline  of  the  premoni- 
tory symptoms  of  apoplexy,  it  must  not  be  supposed  that  such  phenome- 
na never  present  themselves  except  as  the  precursors  of  that  disease. 
All  of  them  will  arise  from  a  disturbed  state  of  the  digestive  organs;  it 
is,  therefore,  of  the  greatest  importance  to  investigate  the  state  of  these 
organs  before  taking  so  serious  a  view  of  the  case.  Generally  speaking, 
if  we  ask  a  patient  whose  brain  evidently  sympathizes  easily  with  his 
stomach,  whether  he  suffers  from  indigestion,  he  says,  "Oh  no,  I  do  not 
know  what  it  is."  He  has  never  been  in  the  habit  of  connecting  his 
uncomfortable  feelings  with  his  stomach.  But  we  perhaps  find,  on  a  lit- 
tle inquiry,  that  he  is  very  irregular  in  his  diet,  not  resting  quietly  after 
his  meals,  and  paying  no  attention  to  his  bowels ;  that  he  has  a  foul 
tongue,  stinking  breath,  and  all  the  usual  signs  of  dyspepsia.  In  doubt- 
ful cases  an  active  aperient  is  the  best  medicine,  and  a  little  careful 
watching  will  soon  decide  as  to  the  danger  of  an  apoplectic  attack; 
always  bearing  in  mind  that  aggravated  dyspepsia  is  itself  a  cause  of 
apoplexy. 

Mental  excitement  has  already  been  considered  as  an  important 
pathognomonic  symptom  of  incipient  meningitis  ;  it  must  also  be  remem- 
bered as  a  possible  forerunner  of  apoplexy.  Dr.  Conolly*  says  that  he 
knew  a  very  corpulent  woman  subject  to  hysteria,  with  some  threaten- 
ings  of  paralysis  of  the  left  side,  who  described  herself  as  feeling  so  well 
and  lively  before  her  worst  attacks  that  she  "  could  not  always  refrain 

*  An  Inquiry  concerning  the  Indications  of  Insanity.  By  John  Conolly,  M.D.,  1S3(X 
London.  Pp.  248. 

24 


370  HUMAN   BRAIN. 

from  singing,"  showing  that  the  capillary  system  of  the  hemispherical 
ganglion  was  at  that  time  in  a  state  of  hypersemia.  In  the  consideration 
of  such  excitement,  for  the  guidance  of  our  diagnosis,  \ve  must,  of 
course,  attend  particularly  to  the  general  character  of  the  constitution, 
and  the  moral  circumstances  which  have  been  lately  influencing  the  pa- 
tient. Case  35  is  a  good  illustration  of  apoplexy  induced  by  moral 
causes. 

Sanguineous  apoplexy  presents  many  interesting  points  for  our  con- 
sideration, both  in  a  practical,  pathological,  and  physiological  point  of 
view.  To  some  of  these  our  attention  shall  next  be  directed. 

In  some  cases  of  apoplexy  the  effusion  takes  place  so  slowly,  and  in 
such  small  quantity,  that  the  real  pathological  character  of  the  disease 
is  easily  passed  over  ;  especially  with  patients  among  the  lower  orders, 
who  are  not  generally  very  clear  in  the  accounts  of  their  ailments. 

The  following  case  is  very  instructive  from  its  insidious  character,  and 
as  illustrative  of  the  value  of  blood-letting  and  mercury  in  the  treatment 
of  this  disease. 

It  is  true  that  we  happily  had  no  autopsy  to  demonstrate  the  exact 
seat  of  the  effusion,  but  I  have  very  little  doubt  that  it  was  in  the  right 
crus  cerebri,  and  that  the  quantity  was  effused  so  slowly  that  the  conduct- 
ing fibres  were  not  ruptured,  only  pressed  on  by  the  blood  effused  be- 
tween them.  If  they  had  been  ruptured,  I  think  there  would  have  been 
more  or  less  spasm  or  convulsion. 

Case  54. — Wm.  Green,  set.  42,  shoemaker,  a  married  man,  temperate  in  his  general  habits, 
but  occasionally  taking  a  little  too  much,  but  not  so  as  to  get  drunk ;  leuco-phlegmatic  tem- 
perament; no  apparent  hereditary  predisposition  to  apoplexy. 

July  5th,  1846. — Applied  to  me  at  the  Dispensary  for  partial  loss  of  power  of  the  left  leg 
and  foot.  On  this  occasion  he  merely  complained  of  a  pain  in  his  loins,  in  addition  to  the 
loss  of  power;  but  said  nothing  to  call  my  attention  to  his  head.  I  ordered  him  to  be  cupped 
on  the  loins,  and  to  take  Pulv.  Jalap,  c.  Cal.  gr.  xv.  h.  n.  Haust.  purgans  eras  mane.  Cal. 
gr.  ij.  Opii  gr.  £,  n.  et  m.,  low  diet. 

On  the  8th,  he  complained  of  some  numbness  in  the  face  and  arm,  and  his  speech  was 
slightly  affected.  It  was  now  evident  to  me  that  there  had  been  some  sanguineous  extra- 
vasation into  some  portion  of  the  cerebral  mass,  and  most  probably  in  the  region  of  the  right 
crus  cerebri.  I  made  further  inquiries,  and  obtained  from  him  the  following  account: — 
About  four  days  previous  to  his  first  visit  to  me,  he  was  attacked  under  the  following  cir- 
cumstances : — His  wife  returned  unexpectedly  from  the  country  with  some  friends  about 
eleven  o'clock;  he  welcomed  them  with  a  little  extra  beer  and  gin.  After  that  he  had  his 
dinner,  about  one;  and  then  went  to  sleep  on  his  bed,  as  was  his  usual  custom  in  the  mid- 
dle of  the  day.  On  waking,  he  found  that  he  had  lost  the  use  of  his  foot,  and  it  felt  numb 
and  pricking,  but  still  he  went  on  with  his  work  as  usual.  Since  the  loss  of  power  in  his 
leg,  but  not  before,  he  has  had  occasional  sharp  pains  across  his  forehead,  but  they  did  not  con- 
tinue; he  felt  occasionally  stupid  in  his  head,  but  this  went  off  again.  He  never  lost  his 
senses.  As  there  was  no  great  power  in  the  pulse,  or  evidence  of  general  plethora,  I  or- 
dered him  to  continue  the  calomel. 

15th. — His  mouth  is  tender  from  the  mercury;  decidedly  better.  Ordered  Mist.  lodin.  et 
dec.  Sarsaparillse  b.  d. 

19th. — Complains  of  his  head.  Ordered  the  Tinct.  lodinii  Comp.  to  the  neck  and*  back 
•of  the  head,  as  a  counter-irritant. 

22d. — He  now  complains  of  some  feeling  of  giddiness,  and  great  pain  in  his  head;  bowel» 
•confined.  Ordered  C.  Cruenta  pone  aures.  ad  ^xij.  Cal.  gr.  ij.  nocte  maneque.  Leave  off 
the  Sarsaparilla. 

Aug.  5th.— Much  relieved:  can  walk  better;  in  his  head  there  is  less  pain,  and  this  is 
confined  to  a  spot  about  the  size  of  half-a-crown.  Ordered,  C.  Cruentae  Ocdpiti  ad  ^viij. 

Aug.  15th. — Much  better;  free  from  pain  in  the  head;  he  can  move  his  arm;  face  better  • 
can  move  his  toes  a  little,  which  he  has  not  been  able  to  do  before  this  time  since  his  seizure. 
Continue  the  calomel. 


APOPLEXY.  371 

Sept.  29th. — Has  continued  the  mercury,  and  he  has  been  gradually  improving  in  health 
and  strength  since  the  last  report.  He  is  now  able  to  walk  nearly  as  well  as  ever ;  all  the 
signs  of  paralysis  have  nearly  disappeared  in  the  face  and  arm,  both  as  regards  the  numb- 
ness and  the  expression  of  the  countenance.  After  this,  I  lost  sight  of  him  until  the  20th  of 
November,  1846.  About  four  years  since  the  loss  of  power  in  the  leg,  but  not  before,  he 
has  had  occasional  sharp  pains  across  the  forehead,  but  they  did  not  continue.  He  felt  occa- 
sionally stupid  in  his  head,  but  this  went  off  again.  He  never  lost  his  senses.  When  he 
first  applied  he  did  not  complain  at  all  of  his  head,  but  only  of  his  leg.  He  was  ordered 
an  active  aperient.  Pulv.  Jalap,  gr.  xv.  Calomel  gr.  v.  statim  sumendus  M.  S.  C.  mane.  C.  C. 
lumbis  ad  ^vi.  Cal,  gr.  ij.  Opii.  i  n.  et  m. 

The  effects  of  sanguineous  apoplexy  are  very  varied,  depending  on 
the  extent  and  the  seat  of  the  effusion. 

Beginning  with  the  medulla  oblongata,  effusion  into  this  part  is  more 
suddenly  fatal  than  any  other.  It  is  the  only  form  of  fatal  apoplexy  that 
resembles  and  is  liable  to  be  mistaken  for  death  from  disease  of  the  heart. 
It  very  seldom  occurs,  for  this  part  is  not  very  vascular ;  the  vessels  are 
not  large,  and  they  are  well  supported.  Effusion  more  frequently  takes 
place  o?i  the  surface  of  this  part  than  into  its  substance,  and  then  it  proves 
equally  fatal,  only  not  so  suddenly.  The  reason  of  effusion  into  this  re- 
spiratory centre  proving  so  rapidly  destructive  to  life,  must  be  obvious 
to  every  physiologist.  It  is  from  this  centre  that  the  nerves  of  respira- 
tion and  the  muscles  which  they  command  receive  their  power  of  action. 
When  blood  is  effused  into  the  third  ventricle  from  rupture  of  the  ves- 
sels of  the  thalami  or  corpora  striata,  it  gradually  finds  its  way  down  to 
the  medulla  oblongata,  and  this  is  a  very  frequent  termination  of  such 
cases. 

When  the  effusion  is  first  into  the  transverse  commissure  of  the  cere- 
bellum (pons  Varolii),  and  secondarily  into  the  medulla  oblongata,  the 
effects  are  often  most  interesting  and  instructive  to  the  physiologist ;  and, 
vice  versa,  the  symptoms  are  so  characteristic  that  the  lesion  may  be 
easily  recognized  by  the  practitioner.  Effusion  into  the  pons  Varolii  pro- 
duces paralysis  of  one  or  both  limbs,  according  to  its  extent ;  but  after 
the  first  effect  of  the  effusion  is  over,  it  does  not  affect  the  intellect,  as 
the  hemispherical  ganglion  is  left  intact.  As  the  blood  advances  to  the 
medulla,  so  are  the  respiratory  organs  affected ;  first,  the  muscles  of  re- 
spiration are  unnaturally  and  irregularly  stimulated,  and  the  sensibility 
of  the  respiratory  passages  abnormally  exalted,  until  the  excitation  is 
succeeded  by  paralysis,  and  the  patient  dies  suffocated.  This  next  case, 
related  by  Ollivier,*  is  peculiarly  instructive.  The  following,  from  Aber- 
crombie,  is  equally  so,  showing  the  absence  of  all  symptoms  of  injury 
to  the  respiratory  system,  and  the  confinement  of  the  extravasation  to  a 
small  portion  of  the  pons. 

Case  55. — Spontaneous  hemorrhage  and  rupture  of  the  cephalic  bulb  of  the  spinal  marrow  and 
of  the  annular  protuberance. — Convulsive  contractions  of  the  limbs. — Stertorous  respiration. — Death 
at  the  end  of  five  hours. — M.  D.,  a  middle-sized  man,  large  head,  short  neck,  broad  shoulders, 
and  large  abdomen,  very  muscular,  being  at  work  in  open  air,  complained  suddenly  of  a  ring- 
ing in  the  ears;  some  minutes  after  he  screamed  from  acute  pain;  he  arose,  commenced  to 
run,  as  if  to  escape  the  danger  which  threatened  him.  After  having  run  for  a  short  distance 
he  fell,  and  presented  the  following  symptoms: — Complete  loss  of  consciousness;  face  pale; 
immobility  of  the  pupil,  which  is  not  dilated,  and  is  of  the  same  diameter  on  both  sides ; 
eyelids  at  first  half  closed,  and  completely  approximated  (the  upper  lid  of  the  right  side  fell 
a  little  subsequently  to  the  left);  immobility  of  the  globe  of  the  eye;  mouth  half  open- 


*  Ollivier,  torn.  ii.  p.  511. 


372  HUMAN   BRAIN. 

tongue  covered  with  arterial  blood,  and  occasionally  protruded,  but  without  permanent  de- 
viation of  its  point ;  lips  covered  with  frothy  saliva ;  no  perceptible  tension  of  the  mouth. 

Respiratory  movements  frequent,  irregular,  accompanied  occasionally  with  stertor,  and 
almost  continually  with  a  sound  similar  to  that  which  is  frequent  in  attacks  of  epilepsy. 
The  alas  nasi  contract  convulsively  with  the  muscles  of  respiration;  twice  there  was  vio- 
lent sneezing,  during  which  the  patient,  who  lay  on  his  back,  bent  forward.  The  limbs  in 
a  state  of  rigidity,  which  is  easily  overcome.  This  contraction,  besides,  is  not  entirely  per- 
manent; it  ceases  for  some  moments,  and  then  the  limbs  are  pliant  enough,  particularly  the 
arm  of  the  right  side;  the  contraction  then  manifested  itself  suddenly,  and  lasted  some  time. 
In  a  word,  these  contractions  seemed  to  hold  a  medium  between  tonic  and  clonic  convulsions, 
though  they  approached  nearer  to  the  latter.  The  contraction  of  the  muscles  of  the  neck 
was  not  strong  enough  to  prevent  the  head,  in  obedience  to  the  laws  of  gravity,  from  in- 
clining to  the  right  or  to  the  left,  forwards  or  backwards,  according  to  the  position  given  to 
the  patient.  With  respect  to  the  sensibility,  it  was  hard  to  determine  whether  it  was  abolished 
pr  not.  There  was  observed  a  convulsive  movement  of  the  right  arm,  when  its  skin  was 
pinched,  and  a  similar  movement  when  the  integuments  were  cut  in  bleeding  him.  Were 
these  movements  owing  to  pain  experienced  by  the  patient  ? 

In  considering  the  almost  convulsive  contractions  of  the  limbs,  during  which  the  arms 
were  rotated  inwards,  and  the  strongly-flexed  state  of  the  thumbs,  and  the  froth  with  which 
the  mouth  was  covered,  one  would  have  thought  it  a  fit  of  epilepsy ;  but  the  patient  never 
presented  any  other  symptom  of  this  disease.  He  died  five  hours  after  the  first  appearance 
of  the  disease.  He  was  not  observed  for  the  last  two  hours.  On  examining  the  body,  the  pons 
Varolii  was  found  changed  into  a  pouch,  filled  with  blood  partly  coagulated,  and  mixed  with 
some  fragments  of  nervous  substance,  softened  and  colored  by  this  liquid.  This  effusion  made 
its  way  laterally  by  a  small  opening,  but  the  principal  rupture  existed  in  the  fourth  ventricle, 
the  floor  of  which,  divided  transversely,  had  given  issue  to  the  blood  which  distended  the 
parietes  of  this  ventricle. 

It  is  to  be  regretted  that  this  patient  was  not  watched  closely  up  to  the  time  he  died,  be- 
cause the  general  paralysis  which  must  have  preceded  it  might  have  been  ascertained.  It 
cannot  be  doubted  but  that  the  spontaneous. hemorrhage  produced  the  cessation  of  motion 
and  sensibility  when  it  occasioned  the  laceration  of  the  entire  substance  of  the  spinal  bulb. 
But  if  this  case  be  incomplete  in  this  respect,  it  is  still  very  important,  in  its  establishing  the 
diagnosis  of  the  effusion  from  its  commencement  in  this  portion  of  the  cerebro-spinal  sys- 
tem. These  symptoms  are  truly  characteristic,  and  present  no  analogy  to  those  which  are 
peculiar  to  other  cerebral  hemorrhages.  I  have  since  had  several  opportunities  of  observing 
this  apoplexy  at  the  moment  of  the  attack,  and  I  have  always  remarked  convulsive  contrac- 
tions in  the  upper  extremities  with  alternating  movements  of  rotation  inwards.  The  open- 
ing of  the  mouth  underwent  no  change.  These  spasmodic  convulsions,  observed  at  the 
commencement  of  the  attacks  of  apoplexy  in  general,  seem  to  me  to  depend  on  the  irrita- 
tion which  the  blood  produces  on  the  extremities  of  the  torn  medullary  fibres,  with  which 
it  remains  in  contact,  and  on  which  it  must  act  as  an  irritant. 

With  respect  to  the  general  paralysis  of  the  upper  and  lower  extremities,  it  has  been 
uniformly  observed  in  all  cases  where,  at  the  post-mortem,  there  has  been  found  an  apoplectic 
cavity  in  the  substance  of  the  protuberance  and  peduncles.  M.  Serres  saw  several  instances 
of  this  hemorrhage,  and  always,  he  says,  complete  immobility  of  the  trunk  and  upper  and 
lower  extremities  took  place  at  the  same  moment  when  the  apoplectic  attack  showed  itself. 
Thus  I  hesitate  not  to  assert,  that  paralysis  existed  during  the  last  hours  before  the  death  of 
the  person  who  is  the  subject  of  the  preceding  case. 

In  the  first  moments  we  saw  that  the  respiratory  movements  were  executed  freely  enough, 
and  were  even  voluntary,  since  the  patient  sneezed  twice,  in  doing  which  he  flexed  the  trunk 
forwards,  and  we  know  that  this  movement  of  respiration  requires  an  effort  of  expulsion 
which  is  impossible  when  the  action  of  the  respiratory  nerves  is  abolished.  It  is  probable 
that  the  hemorrhage,  confined  to  the  protuberance,  and  to  some  fibres  of  the  corresponding 
portion  of  the  peduncles,  did  but  lacerate  them  progressively,  whilst  it  extended  itself 
towards  the  cephalic  bulb,  a  point  where  the  rupture  was  soon  followed  by  death.  The  mani- 
fest movements  made  by  the  patient  when  pinched,  and  when  his  skin  was  cut  in  vene- 
section, show  that  at  the  commencement  the  sensibility  was  not  extinguished ;  and  this  cir- 
cumstance is  precisely  conformable  to  the  seat  of  the  hemorrhage,  when  it  first  occupied,  as 
we  have  seen,  only  the  anterior  fasciculi  of  the  spinal  marrow. 

Death  is  so  much  the  more  rapid,  according  as  the  hemorrhage  is  more  abundant,  and  the 
more  it  involves  the  cephalic  bulb  of  the  spinal  marrow.  The  respiration  becomes  more 
difficult  and  stertorous  also ;  it  becomes  progressively  retarded,  and  the  patient  dies  of  real 
asphyxia;  sometimes,  too,  the  lungs  are  found  emphysematous.  M.  Serres  quotes  two  facts 
which  prove  that  life  may  still  continue  a  long  time,  notwithstanding  the  paralysis  of  the 
upper  and  lower  extremities,  consecutive  on  hemorrhage  of  the  protuberance.  He  met  in 


APOPLEXY.  373 

two  subjects,  even  in  the  midst  of  the  pons  Varolii,  a  cavity  containing  a  yellowish  fluid ; 
there  was  an  induration  of  the  surrounding  cerebral  substance.  The  numerous  excoriations 
on  the  posterior  parts  of  the  body  in  both  subjects,  evident  marks  of  a  long-continued  lying 
on  those  parts ;  the  atrophy  of  the  upper  and  lower  extremities,  equal  on  both  sides,  were 
evident  proofs  of  a  paralysis  of  long  standing,  consecutive  on  the  effusion  into  the  protuberance, 
which  was  partly  absorbed. 

Case  56. — A  gentleman,  aged  37,  had  been  for  several  months  in  bad  health,  being  affected 
with  occasional  tightness  of  the  chest  and  difficulty  of  breathing.  He  had  also  severe  dys- 
peptic complaints,  with  occasional  vomiting,  and  yellow  tinge  of  the  skin,  and  considerable 
uneasiness  in  the  region  of  the  liver.  For  these  complaints  he  had  been  advised  by  his 
medical  attendants  in  the  north  to  go  to  Cheltenham,  and  arrived  in  Edinburgh  with  that 
intention  on  the  22d  March,  1828.  I  saw  him  on  the  following  day  with  Mr.  Wishart. 
We  found  his  pulse  frequent ;  his  countenance  sallow,  and  his  expression  febrile  and  anxious. 
He  complained  chiefly  of  tightness  across  his  chest,  with  some  pain  in  the  region  of  the 
liver.  Respiration  was  very  imperfect  along  the  right  side  of  the  thorax,  and  there  was 
some  cedema  of  the  legs.  By  topical  bleeding,  purging,  &c.,  he  was  considerably  relieved ; 
and  on  the  24th,  he  expressed  himself  as  feeling  much  better,  but  his  pulse  continued  fre- 
quent. On  the  morning  of  the  25th  he  was  suddenly  seized  with  giddiness,  noise  and  con- 
fusion in  his  head,  and  numbness  of  the  whole  right  side.  He  was  oppressed,  but  not 
comatose  ;  answered  questions  distinctly,  but  in  a  loud  voice,  and  with  a  peculiar  manner. 
He  complained  chiefly  of  noise  in  his  head,  of  a  tight  and  cramped  feeling  of  his  right  arm 
and  leg,  with  much  pricking  and  loss  of  command  of  the  parts ;  but  when  desired  to  grasp 
another  person's  hand  with  his,  the  muscular  power  did  not  seem  to  be  diminished.  Th<? 
expression  of  his  countenance  was  vacant  and  fatuous ;  the  eye  was  natural.  The  face  was 
slightly  distorted,  and  the  speech  was  in  some  degree  embarrassed.  The  pulse  was  120. 

After  blood-letting  and  the  other  usual  remedies,  the  symptoms  gradually  assumed  a  more 
favorable  aspect,  and,  after  four  or  five  days,  he  was  considered  as  being  out  of  any  imme- 
diate danger,  though  the  effects  of  the  attack  were  by  no  means  removed.  His  pulse  was 
now  natural,  his  speech  was  distinct,  and  his  mind  entire ;  his  sight  was  good,  and  the  ap- 
pearance of  the  eye  natural,  except  a  slight  degree  of  paralysis  of  the  upper  eyelid  of  the 
light  side.  His  breathing  was  easy,  and  he  made  no  complaint,  except  of  the  tight  and 
cramped  feeling,  with  numbness  of  the  right  arm  and  leg.  His  look,  however,  continued 
vacant  and  peculiar.  His  appetite  and  digestion  were  good,  and  his  bowels  easily  regulated. 
He  was  improving  in  strength,  and  was  able  to  be  out  of  bed  part  of  the  day.  This  favor- 
able state  continued  till  the  14th  of  April,  on  which  day  he  was  found  with  a  very  frequent 
pulse,  without  any  other  change  in  the  symptoms.  This  febrile  state  continued  on  the  two 
following  days  with  rapid  failure  of  strength,  and  he  died  on  the  evening  of  the  16th.  He 
continued  sensible  to  the  last,  and  during  this  febrile  attack  he  seemed  to  have  acquired  an 
increased  command  over  the  limbs  of  the  affected  side. 

About  the  commencement  of  his  illness,  on  the  25th  March,  he  complained  of  considera- 
ble uneasiness  in  passing  his  urine ;  for  a  day  or  two  it  was  bloody,  and  there  was  a  good 
deal  of  tenderness  in  the  region  of  the  bladder.  After  a  few  days  this  subsided,  and  he 
began  to  pass  considerable  quantities  of  puriform  fluid  of  remarkable  fetor,  which  subsided 
to  the  bottom  of  the  chamber-pot  after  the  urine  had  stood  for  a  short  time.  This  continued 
during  the  remainder  of  his  life,  though  it  had  greatly  diminished  in  quantity  for  several  days 
preceding  the  last  febrile  attack.  The  urine  was  in  sufficient  quantity,  and  passed  without 
difficulty. 

Inspection. — The  brain  and  cerebellum  were  found  in  every  respect  in  the  most  healthy 
state,  and  no  vestige  of  disease  was  discovered  until  the  cerebellum  was  separated  from  the 
tuber  annulare.  In  doing  so,  a  cavity  was  exposed  about  the  size  of  a  large  hazel  nut, 
lined  by  a  soft  cyst,  and  full  of  dark  grumous  blood  of  a  firm  consistence.  This  remarka- 
ble cavity  was  formed  partly  in  the  substance  of  the  tuber  and  partly  betwixt  it  and  the 
base  of  the  cerebellum.  It  was  decidedly  more  to  the  left  side  than  the  right,  and  the  sur- 
rounding substance  was  softened,  and  tinged  with  dark  red  points,  as  if  from  injection  of 
dark  blood.  There  was  effusion  in  the  thorax  to  the  amount  of  at  least  Ib.  ij.  The  right 
lung  was  contracted,  and  extensively  hepaiized  ;  the  left  was  much  loaded  with  sero-puru- 
lent  fluid.  The  liver  was  very  considerably  enlarged,  and  of  a  pale  ash  color  and  granu- 
lar texture.  The  left  kidney  was  pale,  indurated,  and  tubercular.  The  inner  surface  of  the 
bladder  was  deeply  injected,  and  in  several  places  showed  distinct  round  ulcers  about  a 
quarter  of  an  inch  in  diameter. 

Effusion  into,  or  on  to,  the  crus  cerebri  will  produce  paralysis  of  the 
extremities  on  the  opposite  side  of  the  body,  and  often  of  the  opposite  eye, 
from  its  affecting  the  optic  nerve,  without  interfering  with  the  sensoriuin. 

fci&  u   ^  ,r*i'-*  .i  *t\  v  zw«l; — titirt.u.v  •muh>> 

Jlvnls    il»    liOM* 


374  HUMAN   BRAIN. 

The  following  case,  though  happily  we  have  no  post-mortem  examina- 
tion to  produce  in  confirmation  of  the  opinion,  is  most  probably  of  this 
kind.  It  shows  also  the  value  of  temperate  and  judicious  treatment. 

Case  57. — May  12th,  1847. — Mr.  W.,  aet.  50,  called  upon  me  in  the  evening,  complaining 
that  he  had  lost  the  use  of  his  right  side.  I  found  that  the  paralysis,  though  not  complete, 
was  unequivocal ;  he  was  able  to  move  his  arm  and  leg  but  very  imperfectly,  and  com- 
plained of  slight  numbness. 

History. — I  learnt  from  him,  that  for  some  time  past  he  has  all  day  been  occupied  in  a  go- 
vernment office,  after  which  he  was  engaged  till  ten  at  night  in  further  mental  labor.  At  this 
time  he  generally  sat  down  to  enjoy  himself,  frequently  taking  three  or  four  glasses  of  brandy 
and  water  before  going  to  bed,  which  was  seldom  before  twelve  o'clock.  He  has  occasion- 
ally suffered  from  dyspepsia,  and  within  the  last  two  days  has  had  two  attacks  of  bilious 
vomiting,  but  had  not  previously  applied  for  medical  advice.  He  states  mat  he  has  suffered 
from  headache  during  the  last  few  days,  which  was  confined  almost  entirely  to  the  right 
side.  His  intellect  is  quite  perfect;  the  left  pupil  is  dilated;  pulse  deficient  in  power,  and 
irregular  both  in  force  and  frequency.  His  first  feeling  of  illness  was  an  inability  to  walk 
as  strong  and  as  well  as  usual.  This  he  experienced  about  three  days  ago.  His  speech  is 
not  affected,  and  he  protrudes  his  tongue  quite  straight ;  there  is  a  very  slight  appearance  to 
dragging  of  the  right  side  of  the  face ;  he  complains  of  severe  pain  shooting  down  the  right 
side  of  the  face;  head  rather  hot. 
^  Ordered — Calomel  gr.  iiij.  4tis-  horae.  Hirudines  xx.  dextri.  lat.  cup.  Emp.  Lyttae  nuchae. 

May  13th,  2  P.M. — Has  passed  a  tolerable  night,  slept  at  intervals;  bowels  opened,  rather 
purged ;  thinks  that  he  has  rather  more  numbness  of  the  left  leg ;  this  was  decidedly  in- 
creased on  his  attempting  to  get  out  of  bed,  but  is  less  numb  now  than  it  was  an  hour  ago ; 
finds  his  head  easier  when  placed  high ;  cannot  incline  it  at  all  to  the  left  side ;  is  more 
comfortable  while  lying  on  the  right  side :  states  that  the  leeches  relieved  his  pain,  but  he 
thinks  that  they  made  him  feel  more  stupid  ;  pulse  same  as  yesterday. 

Ordered — R. — Inf.  Buchu  ^i.  Liq.  Hyd.  Bichlor.  Ji.  Tinct.  Lyttse  IT^x.  sextis.  hor.  sum. 
Hirud.  rept.  Blister  dressed  with  strong  mercurial  ointment,  cold  lotion  to  the  head.  Calo- 
mel omitted. 

14th. — Has  passed  a  quiet,  comfortable  night ;  says  he  is  much  better;  says  he  is  free 
from  pain  in  his  head,  but  that  he  still  suffers  from  a  sense  of  weight  and  difficulty  of  mov- 
ing it  off  the  pillow. 

Bowels  not  open  to-day ;  urine  high  colored. 

The  left  pupil  is  still  slightly  more  dilated  than  the  right,  but  it  acts  quite  naturally  to  the 
light.  The  right  eyelid  is  oedematous,  from  the  irritation  of  the  blister.  He  can  move  his 
arm  and  leg  perfectly.  The  numbness  has  quite  passed  away;  pulse  18-20,  soft  and  regu- 
lar; mouth  tender. 

Pil.  aloes  co.  gr.  x.  adde.  potas.  acet.  gfs.  singulae  dosi  misturae. 

15th. — Better;  can  retain  his  water ;  head  free  from  pain,  but  feels  light.  Mouth  sore, 
pulse  76,  regular. 

19th. — Better;  allowed  to  get  up  for  a  short  time  during  the  day.  Countenance  cheerful 
and  natural ;  pulse  soft  and  quiet;  pupil  of  the  left  eye  still  a  little  larger  than  the  right ;  boil 
on  one  of  the  leech  bites. 

24th. — Both  pupils  nearly  alike ;  all  symptoms  of  paralysis  have  disappeared,  but  he  has 
a  true  carbuncle  on  the  upper  part  of  the  forehead,  on  the  seat  of  one  of  the  leech  bites. 
Incised  the  carbuncle. 

Ordered — Decoct.  Sarsa.  Ibfs.  Ext.  ejus.  gj.  bis  in  die — allowed  a  glass  of  bitter  ale  with 
his  dinner. 

26th. — Carbuncle  spreading;  but  in  other  respects  well;  no  headache;  thinks  the  ale 
agrees  with  him.  Incised  the  carbuncle  again. 

28th. — Much  better;  the  carbuncle  diminished  in  size;  sloughing  stopped.  In  other 
respects  quite  well.  Gave  him  leave  to  go  down  to  the  Isle  of  Wight. 

Remarks. — Whatever  may  have  been  the  seat  of  the  effusion,  the  case  is  one  of  great 
practical  interest.  In  the  first  place,  it  shows  the  value  of  early  attention  to  any  symptoms 
of  paralysis.  It  was  a  case  which  required  great  caution  in  the  employment  of  blood-letting. 
I  doubt  if  he  would  have  recovered  without  some;  but  I  am  quite  sure  if  it  had  been 
pushed  further,  he  would  have  had  either  delirium  tremens  or  sunk  exhausted.  The  appear- 
ance of  the  carbuncle  shows  that  he  would  not  have  borne  depletion.  I  believe  that  mer- 
cury here,  as  in  all  apoplectic  cases,  was  invaluable ;  it  arrested  inflammation,  and  it  pro- 
moted the  absorption  of  the  clot.  With  regard  to  the  cause  of  the  disease,  I  believe  that 
may  be  sought  alone  in  the  over-mental  exertion  with  which  he  taxed  himself;  there  was 
no  indication  of  diseased  heart:  of  the  exact  condition  of  the  cerebral  arteries  we  were  of 
course  ignorant — there  was  no  general  plethora,  or  physical  conformation,  tending  to  the 
disease,  such  as  short,  thick  neck. 


LESIONS    OF   THE   CORPUS    STRIATUM.  375 

Lesions  of  the  Corpus  Striatum. — I  believe  it  is  an  invariable  fact  that 
extravasation  into  the  corpus  striatum  is  followed  by  paralysis  ;  and  con- 
sequently that  there  is  no  portion  of  the  brain  that  pathology  has  so 
clearly  indicated  the  function  of,  as  the  corpus  striatum,  in  so  far  as  its 
connection  with  volition  and  the  production  of  voluntary  motion  is  con- 
sidered. Morgagni,  with  his  usual  acumen,  was  among  the  first  to 
observe  that  disease  or  injury  from  extravasation  into  the  substance  of 
this  body  was  followed  by  paralysis.  In  the  eleventh  letter  of  this 
writer,  we  find  the  following  passage:  "But  whatever  was  the  cause  of 
this  separation  of  the  corpus  striatum,  I  have  already  shown  you,  in  the 
third  letter  which  I  sent  you,  how  often  a  hemiplegia  is  wont  to  happen 
from  an  injury  in  one  or  other  of  these  bodies  or  their  neighborhood. 
Add  to  this  what  the  sepulchretum  teaches,  that  Willis  also  having  some- 
times examined  the  bodies  of  those  who  died  after  a  long  palsy,  and  a 
very  grievous  resolution  of  the  nerves,  had  always  found  these  bodies 
less  firm  than  others  in  the  brain,  being  discolored  like  lees  of  oil,  and 
having  their  striae  greatly  obliterated."  But  I  think  it  will  appear,  from, 
several  facts  I  shall  bring  forward  hereafter,  that  some  physiologists  have 
advanced  too  rapidly  in  theory  when  they  assigned  to  this  body  the 
office  of  conducting  and  producing  the  action  of  the  muscles  of  the 
lower  extremities,  while  the  thalamus  presides  over  and  superintends 
those  of  the  upper. 

Andral,  in  referring  to  this  subject,  makes  the  following  judicious 
remark:  u  Among  the  cases  of  softening  which  we  have  detailed,  there 
are  several  which  seem  to  us  to  form  a  strong  objection  to  the  opinion 
of  those  who  thought  they  had  discovered  in  the  brain  the  particular 
parts  which  preside  over  the  motions  of  the  upper  and  lower  extremi- 
ties. Very  probably  these  particular  parts  do  exist,  since  each  limb 
may  be  separately  convulsed,  paralyzed,  &c.;  but  it  appears  to  us  that 
these  particular  parts  are  yet  to  be  found  out,  and  we  know  nothing 
which  can  be  so  fatal  to  the  sound  doctrine  of  the  localization  of  the 
cerebral  functions  as  those  premature  localizations  which  some  persons 
have  been  inclined  to  establish  in  latter  times." 

In  opposition  to  what  has  been  said  of  the  special  function  of  the 
corpus  striatum  as  presiding  over  the  motions  of  the  lower  extremity, 
the  succeeding  case  may  be  quoted,  in  which  lesion  of  the  part  in  ques- 
tion was  accompanied  with  paralysis  not  of  the  lower  but  of  the  upper 
extremity.* 

Case  58. — Effusion  of  blood  into  the  corpus  striatum  of  the  right  side  ;  sudden  loss  of  conscious- 
ness;  hemiplegia  on  the  left;  death  on  the  fifteenth  day. — A  woman,  48  years  old,  addicted  to 
wine,  fell  suddenly  deprived  of  consciousness  on  the  16th  of  March,  1823.  A  little  time 
after,  she  was  bled;  at  the  end  of  two  hours  ghe  came  to  herself;  she  entered  the  hospital 
of  La  Charite  the  same  evening.  On  the  next  morning  we  found  the  two  extremities  of  the 
left  side  completely  deprived  of  motion  and  sensation.  The  right  commissure  of  the  lips 
was  drawn  upwards ;  intellect  perfect :  pulse  hard,  vibrating,  a  little  frequent.  (She  had 
blisters  to  the  legs,  and  purgatives.)  On  the  following  day  a  visible  amendment;  sensibility 
restored  in  the  paralyzed  side;  the  left  lower  extremity  begins  to  perform  some  movements ; 
the  left  upper  extremity  as  much  paralyzed  as  on  the  preceding  day.  The  19th,  she  moves 
the  leg  and  thigh  of  the  left  side  with  ease;  pulse  not  frequent.  (A  blister  between  the 
ehoulders.)  From  this  period  to  the  1st  of  April,  symptoms  of  gastro-intestinal  irritation 
manifested  themselves;  tongue  red  and  dry;  great  thirst;  tension  of  the  abdomen;  diar- 


*  Andral,  op.  cit,  p.  102. 


376  HUMAN   BRAIN. 

rhoea ;  delirium  soon  came  on ;  the  patient  died  in  what  is  called  the  adynamic  state.  The 
paralysis  of  the  lower  extremity  of  the  left  side  had  been  completely  removed ;  not  so  that 
of  the  upper. 

Post-mortem  examination. — Cranium. — The  only  lesion  presented  by  the  encephalon  was  in 
the  right  corpus  striatum.  Towards  the  middle  part  of  this  substance,  some  lines  beneath 
its  upper  surface,  was  found  a  small  cavity  filled  with  blood.  Around  them  the  cerebral 
pulp  was  very  soft  for  the  space  of  three  or  four  lines. 

Thorax. — Hypertrophy  of  the  walls  of  the  left  ventricle  of  the  heart,  with  contraction  of 
its  cavity. 

Abdomen. — Gastric  mucous  membrane  very  soft  and  red  through  the  entire  splenic  portion. 
Intense  redness,  and,  as  it  were,  granular  appearance  of  the  inner  surface  of  the  ileum 
through  a  great  portion  of  its  extent. 

Remarks. — It  is  rare  to  find  hemorrhage  so  exactly  limited  to  the  corpus  striatum  as  in  the 
above  case.  The  commencement  of  the  affection  was  similar  to  that  of  the  generality  of 
cerebral  haemorrhages,  whatever  be  their  seat.  The  sanguineous  effusion  being  inconsidera- 
ble, the  patient  soon  recovered  the  use  of  her  senses,  and  her  intelligence  continued  quite 
perfect,  which  in  this  case  may  be  referred  to  the  seat  of  the  haemorrhage,  the  effusion  having 
taken  place  far  from  the  substance  of  the  convolutions.  At  first  the  two  extremities  of  the 
side  opposite  to  that  of  the  sanguineous  effusion  were  equally  paralyzed,  which  already  in- 
validates the  opinion  according  to  which  isolated  lesions  of  the  corpus  striatum  should  modify 
motion  only  in  the  inferior  extremity.  But  this  is  not  all;  one  of  the  paralyzed  limbs  soon 
recovers  the  power  of  moving,  and  that  is  the  lower  extremity;  that  is  to  say,  the  limb 
which,  according  to  the  opinion  just  now  mentioned,  should  alone  have  continued  deprived 
of  motion.  Thus,  the  more  we  advance  the  more  will  facts  tend  to  destroy,  or  at  least  to 
stagger,  assertions  too  hastily  made.  There  was  no  appearance  in  this  case  of  any  curative 
process  having  been  set  up  around  the  haemorrhagic  cavity.  The  most  alarming  cerebral 
symptoms  had,  however,  ceased,  and  it  was  under  a  complication  of  gastro  intestinal  inflam- 
mation that  the  patient  sank.  She  had  also  hypertrophy  of  the  heart. 

The  following  case  appears  to  prove  that  the  tract  of  neurine  \vhich 
conveys  the  dictates  of  the  will  to  the  lower  extremities  as  well  as  that 
which  leads  it  to  the  upper  extremities,  partly  passes  through  the  corpus 
striatum  ;  it  also  teaches  us  that  partial  recovery  occasionally  takes  place 
after  apoplexy. 

Case  59. — Traces  of  an  old  effusion  of  blood  into  the  right  corpus  striatum;  hemipkgia,  pre- 
ceded by  loss  of  consciousness:  death  thirteen  months  after  the  attack  of  apoplexy* — A  hair- 
dresser, 46  years  of  age,  entered  La  Charite  the  27th  of  January,  1822.  He  told  us,  that  on 
the  21st  of  February,  1821,  he  had  had  an  attack  of  apoplexy,  during  which  he  said  he  had 
entirely  lost  all  consciousness.  On  coming  to  himself  he  was  paralyzed  in  the  two  extre- 
mities of  the  left  side.  By  degrees  this  paralysis  diminished,  and  when  we  saw  him  he 
merely  felt  some  debility  in  the  left  extremities.  The  arm  of  this  side  appeared  to  him  not 
so  strong  as  the  other,  and  in  walking  he  dragged  the  leg  a  little.  He  presented  all  the  signs 
of  pulmonary  phthisis,  of  which  he  died,  the  14th  day  of  April,  1822. 

Post-mortem  examination. — In  the  posterior  part  of  the  right  corpus  striatum,  nearer  its  ex- 
ternal than  its  internal  part,  about  an  inch  and  a  half  below  its  upper  surface,  a  cavity  was 
found,  an  inch  in  length  and  an  inch  and  a  half  in  breadth.  It  was  filled  with  a  substance 
similar  in  color  and  consistence  to  thick  chocolate.  No  false  membrane  extended  over  the 
parietes  of  this  cavity.  Around  it,  for  the  extent  of  about  half  an  inch,  the  substance  of  the 
corpus  striatum  was  transformed  into  a  yellowish  pulp.  Caverns  and  tubercles  in  the  lungs  ; 
heart  normal;  ulceration  in  the  intestines. 

Remarks. — Here  again  the  lesion  was  confined  to  the  corpus  striatum,  and  still  there  was 
hemiplegia.  Observe,  however,  that  it  was  in  the  posterior  part  of  the  corpus  striatum  that 
the  haemorrhage  took  place.  The  paralysis,  though  considerably  diminished,  existed  how- 
ever, in  a  slight  degree,  at  the  time  of  death.  We  saw  what  was  the  state  of  the  corpus 
striatum  after  the  lapse  of  more  than  a  year  since  the  haemorrhage.  There  was  yet  no  or- 
ganized membrane  on  the  parietes  of  the  cavity,  and  around  it  the  cerebral  substance  had 
neither  the  natural  consistence  nor  color. 

Thalamus  Nervi  Optici. — Extravasation  into  the  thalamus  nervi  optici 
is  not  accompanied  by  any  unequivocal  lesion  of  sensibility,  as  might  be 
-supposed  if  the  theory  that  it  is  the  ganglion  of  the  sensory  column  were 

*  Andral,  p.  103. 


THALAMI   NERVI   OPTICI.  377 

correct.  It  is  indeed  true  that  morbid  anatomy  has  not  yet  shed  any 
clear  light  on  the  functions  of  this  part,  beyond  the  facts  that  volition 
appears  to  flow  through  it ;  for  it  is  seldom  injured  without  paralysis  of 
some  part  or  other  being  the  result.  If  it  is  in  any  way  connected  with 
the  phenomena  of  sensation,  as  its  communication  with  the  posterior 
columns  would  induce  us  to  believe,  it  is  not  entirely  devoted  to  this 
purpose,  for  there  are  many  cases  on  record,  in  which  its  lesions  have 
been  accompanied  with  paralysis,  while  the  sensibility  of  the  parts  para- 
lyzed has  remained  intact.  In  truth,  I  believe  with  Andral,*  that  though 
sensation  is  perhaps  more  frequently  affected  by  cerebral  hemorrhage 
than  motion,  "  it  has  been  impossible  up  to  the  present  time  to  detect, 
in  the  nature  or  in  the  seat  of  the  alterations  of  the  brain,  the  cause 
which  sometimes  suffers  sensibility  to  be  intact,  and  sometimes  occasions 
its  more  or  less  complete  abolition." 

In  the  following  casef  the  lesion  was  so  entirely  confined  to  the  tha- 
lami  that  it  cannot  but  prove  interesting. 

Case  60. — A  man,  60  years  of  age,  was  admitted,  towards  the  commencement  of  No- 
vember, into  the  Maison  de  Sante,  with  a  disease  of  the  heart  of  long  standing.  The  two 
extremities  of  the  left  side  were  also  paralyzed ;  the  intelligence  was  perfect.  About  three 
weeks  before  his  admission,  he  told  us  that  he  felt  his  left  leg  fail  him,  and  he  fell,  not  how- 
ever deprived  of  consciousness.  A  little  after,  he  found  the  upper  extremity  of  the  left  side 
also  deprived  of  motion;  the  sensibility  of  the  paralyzed  limbs  remained.  His  dyspnoea  in- 
creased, as  also  his  dropsy,  and  he  died  on  the  25th  of  November,  the  hemiplegia  continuing 
to  the  last  moment. 

Post-mortem  examination. — In  the  centre  of  the  right  optic  thalamus  there  was  found  a 
cavity  filled  with  black  blood  of  some  consistence.  The  cavity  was  capable  of  containing  a 
large  cherry. 

Thorax. — Lungs  infarcted ;  hypertrophy  of  the  parietes  of  the  heart  and  dilatation  of  its 
cavities,  which  were  filled  with  blood ;  cartilaginous  incrustation  at  the  base  of  the  mitral 
valve  ;  serous  effusion  into  the  left  pleura  ;  close  adhesions  between  the  heart  and  pericar- 
dium. Two  bony  concretions  developed  between  this  membrane  and  the  proper  substance 
of  the  heart. 

Abdomen. — Considerable  injection  of  the  intestinal  mucous  membrane  in  different  parts ; 
spleen  very  large,  dense,  and  black ;  liver  gorged  with  blood. 

Remarks. — This  case  differs  from  all  the  preceding,  in  this,  that  no  loss  of  consciousness 
occurred  when  the  haemorrhage  came  on.  The  two  extremities  of  the  left  side  were  equally 
affected  with  paralysis,  though  the  lesion  existed  but  in  one  optic  thalamus. 

From  the  corpora  striata  and  thalami,  we  may  proceed  to  consider 
those  cases  of  effusion  where  the  blood  is  confined  to  the  tubular  sub- 
stance of  the  hemispheres.  It  is  in  these  cases  that  we  find,  after  the 
first  effect  of  the  effusion  is  passed,  that  the  intellect  remains  intact,  or 
only  slightly  disturbed.  I  have  selected  the  following  case  from  Andral 
in  illustration.  It  also  demonstrates  the  way  in  which  a  false  membrane 
is  sometimes  thrown  round  a  clot  of  blood. | 

Case  61. — Effusion  of  blood  into  the  middle  part  of  the  right  hemisphere.  Some  softening  of 
the  cerebral  substance  around  this  effusion.  Death  the  seventh  month — A  periwig-maker,  se- 
venty-one years  of  age,  of  a  good  constitution,  fell  suddenly,  deprived  of  consciousness,  on 
the  15th  of  May,  1820.  This  loss  of  consciousness  lasted  but  for  some  hours.  When  he 
came  to  himself,  he  found  that  he  was  paralyzed  in  all  the  left  side  of  the  body.  He  en- 
tered La  Charite,  June  28,  and  presented  the  following  state: — Pain  towards  the  summit 
of  the  head,  particularly  on  the  right  side;  sight  and  hearing  weaker  on  the  left  than  on  the 
right;  left  buccal  commissure  immovable,  the  right  drawn  out;  tongue  inclined  to  the  left 
side ;  complete  loss  of  motion  in  the  upper  and  lower  extremities  of  the  left  side ;  sensibility 
of  these  same  members  very  much  impaired,  but  not  quite  extinct ;  obstinate  constipation ; 

*  Andral,  p.  103.  f  Ibid.,  p.  113.  J  Ibid.,  op  cit.,  p.  100. 

*'  '        ' 


378  HUMAN   BRAIN. 

pulse  full,  a  little  frequent;  intellect  perfect.  On  the  4th  of  July,  it  was  observed  that  the 
left  side  of  the  thoracic  parietes  was  covered  with  an  enormous  anthrax.  A  crucial  incision 
was  made  into  it  a  considerable  depth;  whitish  eschars  were  detached  from  it  by  degrees; 
towards  the  end  of  August  it  was  scarcely  cicatrized.  During  the  month  of  September  ano- 
ther anthrax,  still  larger  than  the  former,  appeared  in  the  supra-spinous  fossa  of  the  left 
scapula.  Other  small  ones  appeared  in  succession  in  the  vicinity  of  this  latter  one,  always 
on  the  left.  At  this  time,  the  paralyzed  limb  became  atrophied,  and  permanently  contracted, 
the  forearm  on  the  arm,  and  the  leg  on  the  thigh.  He  complained  when  we  attempted  to 
move  his  limbs.  He  passed  his  urine  and  faeces  involuntarily.  Towards  the  month  of  Oc- 
tober he  became  very  feeble;  scarcely  ever  spoke  ;  large  eschars  formed  on  the  sacrum;  the 
contraction  of  the  left  upper  extremity  ceased,  whilst  it&  immobility  remained.  He  died  the 
21st  of  November,  without  his  respiration  having  become  stertorous. 

Post-mortem. — Complete  marasmus ;  extremities  rigid ;  broad  ulcers  on  saorum  and  tro- 
chanters. 

Cranium. — Its  walls  very  brittle ;  dura  mater  strongly  adherent  to  the  vault  of  the  cra- 
nium ;  arachnoid  of  the  convexity  a  little  opaque ;  right  hemisphere  of  the  brain  presented 
a  cavity  capable  of  containing  a  middle-sized  apple ;  this  cavity  at  an  equal  distance  from, 
the  two  extremities  of  the  hemispheres,  near  the  circumvolutions  of  the  upper  surface,  exter- 
nal, superior  and  posterior  to  the  corpus  striatum.  Its  parietes  were  lined  by  a  cellular 
membrane,  dense,  very  resisting,  in  the  tissue  of  which  numerous' vessels  were  ramified. 
By  its  inner  surface,  this  membrane  adhered  closely  to  the  cerebral  substance,  which  is  re- 
moved along  with  it.  The  cavity  is  filled  with  a  softish  substance  having  the  color  of  iron 
rust.  The  surrounding  cerebral  substance  is  softened  to  the  extent  of  four  or  five  lines. 
The  softened  portion  has  a  slightly  yellow  tinge.  Some  little  serum  in  the  ventricles  and  at 
the  base. 

Extravasations  on  the  surface  of  the  brain  have  sometimes  been  de- 
scribed as  meningeal  apoplexy.  This  is  divisible  into  two  kinds,  one 
into  the  cavity  of  the  arachnoid,  the  other  into  the  sub-arachnoid  tissue. 
Effusion  in  the  arachnoid  cavity  is  never  the  result  of  such  a  decided 
rupture  of  the  vessels,  as  is  visible  to  the  naked  eye,  and  hence  it  has 
been  called  an  exhalation ;  but  wherever  there  are  blood-discs  extrava- 
sated,  there  are  also  openings  in  the  sides  of  the  vessels.  The  blood 
coagulates  in  this  situation,  and  is  frequently  invested  with  a  false  mem- 
brane, which  adheres  to  the  arachnoid.  This  subject  has  been  well  in- 
vestigated by  the  French  writers,  Rostan,  Bayle,  Cruveilhier,  Durant 
Fardel,  and  Dr.  Pruss.  There  is  a  good  abstract  of  the  paper*  of  this 
last-mentioned  author  in  the  British  and  Foreign  Quarterly  Medical  Re- 
view. 

The  disease  has  been  described  by  Carswell  and  Dr.  Burrowes  in  the 
Croonian  Lectures,  and  more  lately  by  Mr.  Prescott  Hewett,  in  the  tenth 
volume  of  the  Medico-Chirurgical  Transactions.  This  careful  patholo- 
gist brings  forward  many  good  instances  of  the  investment  of  the  coagula 
with  a  false  membrane.  He  says,  "  The  pathological  investigations 
carried  on  within  the  last  few  years  by  Messrs.  Longet,  Baillarger,  Cal- 
meil,  Ernest  Boudet,  and  others,  have  all  shown  that  the  fine,  delicate 
membrane  which  covers  these  extravasations  of  blood,  and  which  pre- 
sents to  the  naked  eye  all  the  characters  of  a  serous  tissue,  is  a  newly- 
formed  membrane,  so  beautifully  adapted  to  the  original  serous  membrane, 
that  it  is  only  with  the  utmost  care  that  the  exact  limits  of  each  can  be 
defined.  The  cases  of  this  nature  which  I  have  examined  have  afforded 
me  an  opportunity  of  verifying  the  accuracy  of  this  opinion ;  and  in 
speaking  of  the  formation  of  this  membrane,  I  shall  bring  forward  seve- 
ral examples,  which  will,  I  trust,  prove  that  it  is  much  more  frequently 
and  much  more  rapidly  formed  than  is  usually  supposed. " 

*  M6moire  de  1'Academie  Royale  de  Medecine,  tome  xi.     Paris,  1845. 


MENINGEAL   APOPLEXY.  379 

Mr.  Hewett  considers  that  this  membrane  is  wholly  formed  by  the 
coagulated  fibrine  ofcthe  extravasated  blood,  not  by  a  secretion  of  lymph. 

Pain  in  the  head  always  marks  this  form  of  apoplexy. 

Paralysis  follows  this  effusion,  though  not  so  invariably  as  that  into 
the  cerebral  substance.  One  of  the  most  important  occasional  charac- 
teristics of  this  disease  is  the  intermission  of  the  symptoms,  and  the 
consequent  masking  of  the  disease.  The  following  case  from  Mr. 
Hewett  is  very  instructive,  though  I  cannot  help  saying  that  I  think  the 
existence  of  the  mental  excitement  ought  to  have  warned  the  prac- 
titioner as  to  the  possible  nature  of  the  case,  and  forbade  the  use  of 
quinine. 

Case  62. — In  the  early  part  of  1841,  Mrs. ,  aet.  65,  after  having  for  several  days 

suffered  from  great  mental  excitement,  was  suddenly  seized  with  violent  pain  confined  to  the 
right  eyebrow,  which  lasted  for  two  or  three  hours,  and  then  disappeared.  This  pain  con- 
tinued for  several  days  to  recur  twice  in  the  twenty-four  hours,  presenting  all  the  characters 
of  brow  ague ;  it  was  apparently  relieved  by  quinine,  but  it  was  followed  by  a  train  of 
low  symptoms,  accompanied  by  a  dry  brown  tongue,  wandering  and  impairment  of  the 
intellectual  faculties,  terminating  in  coma.  There  never  was  any  paralysis,  neither  were 
any  contractions  of  the  limbs  observed.  The  patient  died  twelve  days  after  the  first  attack 
of  pain. 

The  body  was  examined  about  twenty-four  hours  after  death.  The  veins  of  the  scalp 
were  gorged  with  blood.  The  dura  mater,  on  the  right  side,  appeared  to  be  somewhat 
thicker  than  natural.  A  large  quantity  of  blood  was  found  extravasated  in  the  cavity  of 
the  arachnoid ;  it  corresponded  both  to  the  upper  and  to  the  inferior  surfaces  of  the  right 
hemisphere,  and  a  small  quantity  of  it  had  even  made  its  way  into  the  corresponding  cere- 
bellic  fossa,  where  it  was  lying  on  the  margin  of  the  foramen  magnum;  the  whole  of  this 
extravasated  blood  was  of  a  dark  fawn  color.  At  the  base  of  the  skull,  the  extravasa- 
tion at  first  sight  appeared  to  have  taken  place  between  the  dura  mater  and  its  arachnoid 
lining,  for  the  blood  was  covered  by  a  thin,  smooth,  and  polished  membrane,  presenting  to 
the  naked  eye  all  the  characters  of  the  serous  tissue,  with  which  it  was  perfectly  continuous, 
at  the  margins  of  the  extravasation ;  but  this  membrane,  and  the  clot,  were  easily  removed, 
and  the  arachnoid  was  then  found  slightly  roughened,  but  uninterrupted  throughout  in  its 
continuity.  The  substance  of  the  brain  was  healthy,  but  its  ventricles  contained  some  fluid. 
The  source  of  the  haemorrhage  was  not  discovered.  No  marks  of  external  violence  existed 
about  the  cranium. 

This  form  of  apoplexy  is  not  so  invariably  fatal  as  that  into  the  sub- 
arachnoid  tissue.  Its  duration  is  certainly  longer;  Dr.  Prus  says  that 
it  may  extend  a  month,  and  upwards,  and  as  a  proof  that  recovery  does 
sometimes  take  place,  cites  the  discovery  of  cysts  in  the  serous  cavity. 
I  was  present  at  the  inspection  of  a  case  of  this  kind  at  Bethlem,  April, 
1842.  The  patient  had  had  symptoms  of  an  apoplectic  seizure  two 
years  previous  to  his  death,  from  which  he  recovered.  On  the  internal 
surface  of  the  parietal,  or  reflected  portion  of  the  arachnoid,  there  was 
a  false  membrane  of  a  brown  yellowish  color,  about  as  thick  as  a  piece 
of  stout  writing  paper,  near  the  mesial  line,  but  gradually  diminishing 
in  thickness  to  that  of  a  mere  cobweb,  at  the  base  of  the  skull.  The 
visceral  arachnoid  was  thick  and  milky,  the  cerebro-spinal  fluid  abund- 
ant beneath. 

The  symptoms  which  mark  extravasation  on  the  surface  of  the  brain 
into  the  sub-arachnoid  tissue  depend  very  much  on  the  seat  and  rapidity 
of  the  effusion.  When  injuries  of  the  skull  give  rise  to  effusion  of 
blood,  I  oftentimes  remarked  that,  as  long  as  the  blood  was  confined  to 
the  base  of  the  brain,  the  mind  was  little  affected,  but  as  the  blood  rose 
upwards  and  reached  the  upper  part  of  the  hemispheres,  that  then  coma 
and  insensibility  would  come  on.  The  proof,  that  the  effusion  com- 


380  HUMAN   BRAIN. 

menced  at  the  base,  was  the  discovery  of  the  ruptured  vessel,  generally 
the  middle  meningeal  artery.  I  have  not  had  the  opportunity  of  observ- 
ing whether  the  same  applies  to  apoplectic  effusion,  but  I  can  see  no 
reason  to  doubt  it.  Hemiplegia  seldom  follows  this  form  of  effusion, 
and  this  most  probably  arises  from  the  blood  being  poured  into  the  cavity 
of  the  cerebro-spinal  fluid,  which  readily  makes  way  for  it. 

Dr.  Prus  sets  down  the  cephalalgia,  redness,  and  heat  of  the  integu- 
ments of  the  face,  as  premonitory  symptoms,  rather  than  evidences  of 
the  actual  occurrence  of  the  haemorrhage.  I  do  not  agree  with  him,  as 
I  am  convinced  that  in  many  cases  the  haemorrhage  goes  on  very  slowly 
at  first.  It  is  very  true,  as  stated  by  this  author,  that  the  intellectual 
faculties  are  scarcely  ever  perverted ,  but  weakened.  The  reason  is,  that 
the  hemispherical  ganglion  is  not  usually  inflamed  in  these  cases,  it  is 
only  compressed,  and  hence  the  most  constant  effect  is  coma. 

Apoplectic  effusions  on  the  surface  generally  arise  from  the  rupture  of 
small  vessels:  sometimes  no  rupture  whatever  can  be  found,  and  some- 
times they  are  the  consequence  of  ulceration.  When  the  effusion  takes 
place  slowly,  the  pain  experienced  is  excessive,  it  is  excruciating,  there 
is  blood  enough  to  irritate  the  membranes  and  elicit  that  sensibility  which, 
like  the  peculiar  sensibility  of  every  tissue,  is  a  warning,  protective 
sensibility,  but  not  enough  to  smother  the  instrument  whose  office  it  is 
to  receive  impressions  and  recognize  pain.  Sometimes  this  suffering 
may  last  for  some  days,  but  generally  coma  comes  on  rapidly  and  re- 
lieves the  pain.  One  of  the  most  striking  cases  I  ever  saw  of  this  kind, 
occurred  in  the  person  of  an  old  servant.  On  the  morning  she  was 
about  to  quit  the  service  of  a  family  where  she  had  lived  many  years 
most  happily,  she  awoke  with  severe  pain  in  the  head ;  she  got  up,  and 
attempted  to  pack  her  boxes,  and  do  other  little  things  as  usual,  but  she 
soon  felt  too  ill  to  do  anything,  and  she  was  obliged  to  go  to  bed  again. 
Medical  treatment  had  no  power  over  the  attack,  and  she  died  comatose 
on  the  fifth  day,  without  any  appearance  of  hemiplegia.  The  only  lesion 
discovered  was  an  effusion  of  blood  over  the  whole  of  the  upper  part  of 
the  brain ;  it  was  smeared  with  blood.  No  ruptured  blood-vessel  could 
be  discovered. 

The  following  case  is  peculiarly  interesting  and  instructive,  from  the 
obscurity  of  its  symptoms  and  the  insidious  character  of  its  onset : — 

Case  63. — Sanguineous  Apoplexy — very  obscure  symptoms. — M.  C ,  set.  38,  pale,  and  of 

fair  complexion,  short  stature,  robust,  energetic  and  muscular  appearance,  and  of  well-ordered 
habits,  has  been  married,  and  has  had  five  children,  the  last  of  whom  is  five  months  old. 
She  was  nursing  at  the  time  of  seizure,  on  the  evening  of  the  15th  of  November,  having 
been  perfectly  well  and  active  to  the  period  of  attack ;  she  was  suddenly,  and  without 
cognizable  cause,  seized  with  severe  and  repeated  vomiting,  with  partial  loss  of  conscious- 
ness. 

I  saw  her  about  twenty  minutes  after  the  commencement  of  vomiting,  and  found  her  sit- 
ting in  a  chair;  the  pulse  was  very  small  and  feeble,  about  105;  the  surface  of  the  body  cool 
and  clammy;  the  eyes  natural  in  their  appearance;  the  pupils  perfectly  sensible,  and  con- 
sciousness much  restored.  She  knew  every  body  and  everything,  but  had  some  hesitation  in 
replying  to  questions ;  but  the  answers  were  all  perfectly  correct ;  muscular  power  appeared 
very  weak,  but  under  control ;  she  complained  of  headache,  and  said  she  felt  very  ill ;  retch- 
ing continued  very  troublesome.  The  contents  of  the  stomach  having  been  previously  ex- 
pelled, small  quantities  of  mucus  were  ejected.  Bowels  constipated. — Ordered  to  be  put  to 
bed,  her  head  raised,  and  cold  lotion  applied ;  hot  bottles  to  the  feet  and  legs,  Hyd.  Chlorid. 
gr.  viij.  stat.  Magn.  Sulph.  Jfs.  ex.  aquae  Cinnamomi  gifs.  post  horam  dimidiara. 

1-  ,.:'"•>    *.?»JIO9  ^IffUfW^tM    ..•!:£ 


MENINGEAL  APOPLEXY.  381 

Saw  her  again  in  forty  minutes ;  had  thrown  up  the  powder  and  draught ;  pulse  quite 
small  and  feeble ;  sensibility  rather  more  obtuse ;  she  still  answered  all  questions  correctly, 
and  the  pupils  were  sensible ;  but  she  took  very  little  notice  without  cause  to  do  so.  Head 
to  be  shaved,  and  cold  lotions  applied;  large  mustard  poultices  to  the  scrobiculus  cordis  and 
calves  of  the  legs.  Calomel  gr.  v.  4ta  hora.  H.  Salinus.  post  sing.  dos. 

I  visited  her  again  in  three  hours.  Pulse,  intellect,  and  other  symptoms  the  same;  the 
surface  of  the  body  had  become  warmer.  She  had  had  the  mustard  poultices  on  for  about 
two  hours;  the  skin  was  much  inflamed  under  them;  but  when  questioned,  said  they  pained 
her  only  slightly.  Muscular  power  and  sensation  very  much  depressed,  though  not  paralyzed. 
Contin.  gruel  only,  for  sustenance. 

16th. — Pulse  rather  rallied  still  small  and  weak;  retching  not  quite  so  troublesome,  but 
was  still  continuing,  and  the  medicine  had  been  ejected;  head  was  still  painful;  pupils  sen- 
sible, intellect  obtuse,  but  her  replies  more  correct;  the  mammae  were  secreting,  and  the 
child  was  ordered  to  be  put  to  the  breast.  A  purgative  enema  administered  immediately. 
Calomel  gr.  ij.  3fia-  hora.  Hs.  Aper.  6ti8<  horis.  Blister  to  the  scrobiculus  cordis,  and  behind 
the  ears.  Continue  the  cold  lotion  to  the  head. 

17th,  mane. — Intellect  rather  more  obtuse;  other  symptoms  same  as  yesterday;  bowels 
had  been  freely  acted  upon  by  the  enema  yesterday. — Cont.  Cal.  et  Hs.  Sal.  Emp.  Lyttse 
capiti. 

Vespwe. — Consciousness  and  sensibility  much  more  blunted  and  impaired;  when  excited 
to  do  so,  answered  questions,  but  irrationally ;  did  not  generally  identify  persons  around  her, 
and  when  questioned  as  to  how  she  was,  answered — Quite  well;  pupils  still  contract,  but 
not  so  sensitive.  When  I  saw  the  patient  she  was  still  asleep.  Her  manner  was  rational, 
and  not  peculiar ;  but  when  asked  who  Mr.  W.,  her  medical  attendant,  was,  said  he  was 
somebody  else — evidently  did  not  know  him.  When  left  to  herself,  she  soon  dozed  off 
again,  from  which  state  she  was  roused  again  with  difficulty,  though  it  was  unaccompanied' 
by  stertor.  When  roused,  she  answered  the  'inquiry  how  she  was  distinctly,  though  slowly ; 
that  she  felt  very  well — that  she  had  no  pain  anywhere.  I  examined  the  pupils  before  she 
awoke,  and  they  then  contracted  decidedly  and  forcibly  to  the  light;  after  she  awoke,  they 
also  contracted  to  the  light,  though  not  so  much,  but  both  acted  equally.  The  pulse  was 
100,  and  rather  jerking,  not  very  easily  compressed,  but  still  not  giving  the  idea  of  much 
power.  The  head  was  rather  hot,  but  not  decidedly  so.  There  were,  in  fact,  no  decided 
symptoms.  However,  taking  into  consideration  the  progress  of  the  disease,  and  the  fact 
that  she  was  hourly  getting  more  stupid  and  sleepy,  and  there  was  a  jerking  character  of 
pulse,  I  thought  it  right  to  abstract  a  little  blood  from  the  arm,  taking  care  to  watch  its 
effects.  The  blood  flowed  from  a  free  opening,  and  the  pulse,  after  the  abstraction  of  three 
or  four. ounces,  became  a  little  feebler,  but  when  there  were  six  taken,  it  became  slightly 
intermittent,  and  this  became  more  decided.  I  stopped  the  bleeding,  taking  only  seven 
ounces.  She  was  a  little  more  sensible  after  the  bleeding,  but  the  change  was  very  slight. 
Ordered  Hyd.  Chlorid.  gr.  ij.  tertia  hora.  Hyd.  Bichlorid.  gr.  ij.  Syrup.  Croci  Tinct.  Lyttas 
£ifs.  aq.  Menth.  £viij.  6tara-  partra-  omni  hora.  R.  Olei  Tereb.  if  i.  Tinct.  Assafetid.  gi. 
aq.  J  viij.  fiat  enema. 

During  the  night,  and  after  I  left  her,  I  understand  she  was  a  little  more  conscious,  but 
it  did  not  last  long,  for  she  sank  about  ten  the  next  morning. 

Post-mortem — 44  hours. — Head. — Vessels  of  pia  mater  very  full,  arachnoid  natural.  Be- 
fore removing  the  brain  from  the  skull,  we  observed  a  slight  sanguineous  effusion  extending 
over  the  upper  surface  of  the  anterior  lobes,  below  and  before,  backwards,  forming  a  very 
thin  layer — a  mere  smearing  of  the  brain.  On  removing  the  brain  from  the  skull,  I  found 
the  under  part  of  the  right  anterior  lobe  so  soft  that  it  gave  way  to  the  finger,  and  when  the 
brain  was  removed,  we  found  the  anterior  portion  of  the  corpus  callosum  also  torn  and  evi- 
dently softened.  The  layer  of  effused  blood  was  thicker  between  the  two  hemispheres 
than  at  the  upper  part,  and  was  gradually  thickened  as  we  traced  it  from  above  downwards, 
round  the  front  of  the  brain  to  the  base ;  it  evidently  proceeded  from  a  vessel  which  had 
given  way  close  to  the  fissura  Sylvii;  in  the  substance  of  the  brain  opposite  the  fissure, 
there  was  a  clot  about  the  size  of  a  hazelnut — the  brain  softened  and  discolored  around  it. 
This  effusion  had  just  penetrated  the  wall  of  the  anterior  cornu  of  the  lateral  ventricle,  for 
in  it  there  was  a  small  quantity  of  liquid  blood  smearing  its  floor,  also  the  posterior  cornu; 
all  the  rest  of  the  brain  was  healthy. 

Chest. — Lungs  sound.  Concentric  hypertrophy  of  left  ventricle,  with  diminution  of  the 
cavity.  The  walls  were  double  their  normal  thickness;  the  cavity  about  half  its  natural 
size.  The  aortic  opening  was  narrow;  and  along  the  attached  edges  of  the  semilunar  valves 
there  was  a  slight,  narrow,  cartilaginous  thickening,  also  some  deposit  of  cartilaginous  matter 
in  the  mitral  valve.  Right  ventricle  a  little  dilated.  The  rest  of  the  viscera  healthy. 

This  case  was  one  of  the  most  obscure  I  ever  met  with.    There  were 


HUMAN   BRAIN. 

none  of  the  ordinary  signs  of  sanguineous  apoplexy — no  paralysis  of 
either  motion  or  sensation — no  morbid  impression  on  the  retina — no 
stertor — no  suffusion  of  the  eyes,  no  congestion  of  the  head — neither 
were  there  any  signs  of  inflammation  of  the  membranes  of  the  brain  or 
hemispherical  ganglia.  The  condition  of  the  patient  seemed  to  point 
more  to  serous  effusion  at  the  base  of  the  brain,  and  there  -was  nothing 
in  either  the  history  of  the  case  or  appearance  of  the  patient  to  make 
me  regard  it  as  asthenic  in  its  character  and  the  danger  of  the  patient 
as  imminent.  I  ventured  on  the  abstraction  of  blood,  and  I^am  now 
sorry  we  did  not  carry  it  further. 

The  following  case  from  Ducrot,  (Essai  sur  la  Cephalite,  1812,  Obs. 
2,)  quoted  by  Lallemand,  illustrates  the  progressive  effects  of  extrava- 
sation of  blood  in  exciting  inflammatory  action  of  the  tubular  substance, 
and  with  it  convulsive  movements ;  these  being  followed  by  paralysis, 
as  the  brain  becomes  softened,  and  the  conducting  instruments  destroyed. 

Case  64. — Mr.  A.,  about  60  years  of  age,  had  a  fracture  with  a  depression  into  the  left 
frontal  region  by  a  stone  thrown  with  violence;  he  lost  much  blood,  but  was  able  to  return 
home.  The  next  day,  throbbing  pains  came  on,  with  confusion  of  memory  and  inability  to 
give  proper  answers  to  questions;  power  of  speech  not  much  impaired,  but  incapability  of 
putting  the  tongue  out.  The  pulse  was  feeble;  oppression.  (A  liquid  emetic.)  The  third 
day  deglutition  difficult,  thirst,  skin  hot,  pulse  frequent.  The  fourth  day,  drowsiness,  answers 
always  correct.  (A  large  blister  to  the  nape  of  the  neck.)  Fifth  day,  drowsiness  increases, 
loss  of  speech:  he  understands  what  is  said  to  him,  but  can  only  answer  by  cries;  the  faeces 
and  urine  pass  involuntarily.  Sixth  day,  drowsiness  still  more  increassd,  symptoms  the 
same.  Seventh  day,  no  alteration.  Eighth  day,  delirium,  loss  of  sense,  convulsive  motions 
of  the  trunk  and  limbs,  with  distortion  of  the  mouth  and  eyes;  he  had  attacks  every  quarter 
of  an  hour.  In  the  interval  respiration  difficult,  snoring,  eye  fixed,  gaping  mouth.  The 
ninth,  at  midnight,  the  convulsions  cease,  the  drowsiness  diminishes,  his  senses  return,  but 
the  alteration  of  memory  and  judgment  continue;  slight  delirium,  the  left  limbs  begin  to  be 
paralyzed.  The  tenth,  complete  paralysis  of  these  limbs,  with  rigidity  and  slight  pain  when 
they  were  raised  from  the  trunk ;  the  countenance  idiotic,  answers  not  correct,  optical  illu- 
sions, convulsive  jerkings  during  the  night.  The  following  day  same  state.  The  eleventh 
day,  loss  of  sense,  aphonia,  immobility  and  general  insensibility,  coma,  respiration  loud  and 
difficult,  &c. ;  death  at  eleven  in  the  evening. 

Autop.  cadav. — Depression  two  lines  in  depth  for  about  two  inches  on  the  frontal  region. 
At  the  internal  and  posterior  part  of  the  right  lobe  of  the  brain,  inflammation  an  inch  and 
a  half  in  extent  from  above  to  below,  and  half  an  inch  in  the  other  direction,  extending 
on  one  side  as  far  as  the  corpus  callosum,  and  on  the  other  to  the  base  of  the  brain.  This 
inflammation  was  marked  with  a  bright  redness,  sprinkled  as  it  were  through  the  substance 
of  the  brain.  The  arachnoid,  which  covered  the  convexity  of  the  brain,  was  opaque,  white, 
very  thick,  and  smeared  upon  its  internal  surface  by  a  thin  layer  of  albuminous  matter. 

Our  attention  may  next  be  directed  to  the  effect,  and,  consequently, 
the  symptoms  of  apoplectic  effusion  on  or  into  the  Cerebellum.  These 
lesions  are  always  more  or  less  followed  by  hemiplegia,  and  this  is,  I 
believe,  invariably,  as  in  the  instance  of  brain,  on  the  opposite  side  of 
the  body.  Sight  and  hearing  are  generally  secondarily  affected  from  the 
propinquity  of  the  optic  ganglia  and  auditory  nerves. 

In  many  cases,  though  not  in  all,  we  find  decided  disturbance,  ge- 
nerally excitement  of  the  generative  organs. 

The  following  case  is  interesting  in  many  points  of  view ;  first,  it  is 
an  instance  of  a  moral  cause — fright  so  exciting  the  cerebral  circulation 
as  to  give  rise  to  effusion ;  secondly,  the  gradual  loss  of  power,  the 
effusion,  in  all  probability,  being  very  small  ;  thirdly,  the  effect  on  the 
organs  of  vision  ;  fourthly,  the  supervention  of  inflammation  in  the 
cerebellum,  and  its  effect — convulsive  movements ;  fifthly,  the  super- 


APOPLEXY  OF  THE  CEREBELLUM.  383 

vention  of  inflammation  of  the  hemispherical  ganglion  and  its  effect — 
delirium ;  sixthly,  effusion  into  the  ventricles,  and  its  effect — coma. 

Case  65. — Considerable  softening  of  the  right  lobe  of  the  cerebellum,-  with  hemiplegia* — A 
seamstress,  thirty-one  years  old,  who  had  hitherto  enjoyed  good  health,  about  six  weeks 
before  entering  the  hospital  of  La  Charit£,  had  a  fright  whilst  menstruating :  the  menses 
were  suppressed,  and,  immediately  after  their  disappearance,  she  was  seized  with  dizziness, 
and  an  acute  pain  in  the  back  part  of  the  head,  towards  the  right  side.  The  dizziness 
disappeared  after  a  bleeding,  but  the  pain  of  head  remained ;  it  was  unconnected  with  any 
other  symptom  for  eight  days ;  subsequently  the  patient  began  to  experience  an  annoying 
sense  of  formication  at  the  ends  of  the  fingers  of  the  left  hand  ;  she  could  use  this  hand  but 
awkwardly,  and  was  astonished  at  seeing  what  she  handled  with  it  fall  continually  from 
her  grasp :  she  soon  became  unable  to  work  with  it  at  all ;  the  entire  arm  seemed  very 
heavy.  After  some  time  the  lower  extremity  of  the  left  side  became  weaker,  and  in  about 
a  month  the  patient  had  complete  hemiplegia  of  the  left  side.  At  the  same  time  that  the 
patient  thus  lost  the  power  of  motion  of  one  of  the  sides  of  the  body,  her  sight,  till  then 
extremely  good,  became  very  weak,  and  five  weeks  after  the  invasion  of  the  first  symptoms, 
she  became  completely  blind. 

This  was  the  state  in  which  we  first  saw  her ;  deprived  of  sight,  and  of  the  power  of 
moving  the  limbs  of  the  left  side;  the  pain  of  head  had  then  become  less  acute;  the  patient, 
however,  still  felt  it,  and  referred  it  to  the  lower  part  of  the  occipital  region  of  the  right  side. 

The  paralyzed  limbs  were  flaccid,  and  could  be  moved  in  all  directions  ;  the  skin  covering 
them  still  retained  its  sensibility;  no  trace  of  paralysis  of  the  face;  the  pupils,  moderately 
dilated,  still  contracted  on  the  sudden  approach  of  light;  the  appearance  of  the  eyes  was 
natural ;  there  was,  however,  all  but  complete  blindness,  the  patient  being  scarcely  able  to 
distinguish  day  from  night;  the  intellect  was  perfect,  the  pulse  natural;  the  catamenia 
had  not  reappeared  since  they  were  suppressed  by  the  fright.  Leeches  were  first  applied 
to  the  nape  of  the  neck,  then  to  the  genital  organs ;  aloetic  pills  were  frequently  given,  and 
subsequently  the  back  of  the  head  was  covered  with  a  blister. 

No  change  appeared  for  the  first  three  weeks  of  her  stay  in  the  hospital ;  then,  without 
any  known  cause,  the  pain  of  head  suddenly  became  more  violent,  and  extended  to  the 
entire  cranium  ;  the  extremities  of  the  left  side,  which  till  then  had  remained  entirely  im- 
movable, were  several  times  agitated  with  convulsive  movements,  which  were  slight  in  the 
lower  extremity,  but  very  violent  and  almost  continual  in  the  upper  limb ;  acute  pains  ac- 
companied these  convulsions ;  the  intelligence  soon  became  disturbed ;  complete  delirium 
set  in  ;  for  twenty-four  hours  the  patient  spoke,  and  was  agitated  incessantly  ;  she  then  fell 
into  a  profound  coma,  in  which  state  she  died. 

Postmortem  examination. — The  pia  mater  extending  over  the  convexity  of  the  cerebral 
hemispheres  was  very  much  injected,  as  was  also  that  covering  the  cerebellum.  The  sub- 
stance of  the  brain,  properly  so  called,  was  marked  with  a  considerable  number  of  red 
points,  and  presented  no  other  lesion ;  lateral  ventricles  distended  with  a  great  quantity  of 
limpid  serum  ;  the  fornix  and  septum  lucidum  natural.  Externally  the  cerebellum  appeared 
healthy ;  but  we  had  scarcely  removed  some  layers  of  the  substance  of  its  right  hemisphere, 
proceeding  from  above  downwards,  when  we  found  an  immense  cavity,  where  this  sub- 
stance, deprived  of  its  normal  consistence,  was  changed  into  a  grayish  bouillie;  this  softening 
occupied  at  least  two-thirds  of  the  right  hemisphere  of  the  cerebellum ;  it  partly  implicated 
the  prolongations  which  go  from  the  cerebellum,  either  to  the  spinal  marrow,  or  to  the 
tubercula  quadrigemina,  or  to  the  annular  protuberance :  it  did  not  extend  as  far  as  the  lower 
surface  ;  in  no  part  of  its  extent  was  there  either  injection  or  infiltration. 

Case  66. — Effusion  of  blood  into  the  right  hemisphere  of  the  cerebellum,'  hemiplegia  of  the  left  side, 
accompanied  with  loss  of  consciousness.  Death  50  hours  after  the  appearance  of  the  first  apoplectic 
symptoms.^ — A  female,  22  years  of  age,  was  treated  at  the  hospital  of  La  Charite  for  a  chronic 
gastritis;  she  had  evinced  symptoms  of  this  affection  for  the  last  two  years.  One  evening 
at  six  o'clock,  a  short  time  after  having  eaten,  and  before  going  to  bed,  she  fell,  suddenly  de- 
prived of  consciousness  and  motion.  After  about  an  hour  she  recovered  the  use  of  her 
senses,  but  could  not  move  the  extremities  of  the  left  side.  On  seeing  her  the  next  morning 
her  state  was  as  follows:  face  injected  equally  on  both  sides,  contraction  of  the  pupils,  vision 
unimpaired,  air  of  stupor ;  she  answers  questions  with  correctness,  no  embarrassment  of 
speech.  The  two  extremities  of  the  left  side  completely  deprived  of  voluntary  motion ;  they 
presented  no  trace  of  contraction ;  sensibility  of  the  skin  covering  them  impaired.  Pulse  75, 
and  full;  heat  of  skin  natural;  respiration  hurried,  30  to  34  every  minute. 


*  Andral's  Clinique  Medicale,  sect.  ii.  Case  I.  p.  202. 
f  Andral,  op.  cit,  p.  195. 


384  HUMAN   BRAIN. 

This  girl  seemed  to  us  to  have  been  struck  with  cerebral  haemorrhage ;  she  was  bled  to 
sixteen  ounces.  This  produced  no  amendment,  and  the  symptoms  going  on  from  bad  to 
worse,  the  patient  expired  on  the  evening  of  the  day  on  which  she  was  first  seen. 

Post-mortem  examination. — Cranium. — Sub-arachnoid  cellular  tissue  of  the  convexity  of  the 
cerebral  hemispheres  very  much  injected.  The  latter  present  no  appreciable  alteration,  ex- 
cept considerable  sandiness  of  their  tissue.  In  the  central  part  of  the  right  hemisphere  of 
the  cerebellum  was  found  an  effusion  of  blood,  which  formed  in  the  nervous  substance  a 
cavity  large  enough  to  hold  a  pullet's  egg.  Around  this  cavity  the  tissue  of  the  cerebellum 
was  red  and  softened  for  the  space  of  three  or  four  lines. 

A  man  mentioned  by  Serres,*  after  a  blow  on  the  back  and  lateral 
part  of  the  head,  which  stunned  him  at  the  time,  had  a  certain  unsteadi- 
ness in  walking,  which  made  him  always  anxious  to  take  the  arm  of  a 
friend  ;  and  he  had  a  weakness  of  his  head,  which  made  him  liable  to 
be  much  affected  by  a  small  quantity  of  wine.  This  state  continued 
about  eighteen  months,  when  he  became  low  spirited  and  irritable,  and 
was  affected  with  trembling  of  the  limbs.  Soon  after,  the  left  leg  be- 
came paralytic,  and  the  arm  of  the  same  side  felt  benumbed  and  weak- 
ened. After  the  insertion  of  a  seton  in  the  neck,  the  arm  recovered. 
Three  months  after  this  the  patient  died,  with  fever,  delirium,  and  an 
affection  of  the  bowels. 

There  was  found  disease  in  the  right  lobe  of  the  cerebellum,  with  an 
abscess  and  extensive  softening. 

In  another  man,  mentioned  by  the  same  writer,  who  died  in  forty  days, 
there  was  palsy  of  the  right  leg,  with  wasting  of  the  limb,  but  without 
loss  of  sensibility,  the  arm  of  the  same  side  being  little,  if  at  all, 
affected. 

There  was  found  ramollissement  of  the  left  lobe  of  the  cerebellum, 
occupying  chiefly  the  centre  of  the  left  peduncle. 

The  cases  above  referred  to  prove  that  lesions  of  the  cerebellum,  like 
those  of  the  cerebrum,  generally  produce  paralysis  of  the  side  of  the 
body  opposite  to  the  seat  of  injury.  In  some  cases  the  sensibility  was 
decidedly  impaired,  but  in  others  this  function  scarcely  presented  any 
signs  of  implication. 

One  of  the  most  interesting  and  extraordinary  circumstances  connected 
with  injuries  of  the  cerebellum  with  which  I  am  acquainted,  I  give  on 
the  authority  of  Andral.f 

"  When  the  hemorrhage  of  the  cerebellum  occurs  simultaneously 
with  that  of  the  cerebrum,  or  a  little  time  after  it,  but  so  that  the  blood 
is  effused  on  the  right  into  the  cerebellum,  and  on  the  left  into  the  cere- 
brum, or  vice  versa,  there  is  paralysis  only  on  the  side  of  the  body  oppo- 
site to  the  hemisphere  of  the  brain  where  the  haemorrhage  has  taken 
place ;  that  is,  on  the  same  side  as  the  haemorrhage  of  the  cerebellum. 
How  then  does  it  come  to  pass,  that  whereas  the  movements  of  the  ex- 
tremities of  the  right  side  are  abolished  when  there  is  an  effusion  of 
blood  into  the  left  hemisphere  of  the  cerebrum,  the  effusion  which  takes 
place  simultaneously  into  the  right  hemisphere  of  the  cerebellum  should 
no  longer  have  the  power  of  paralyzing  the  extremities  of  the  left  side? 
It  had  this  power,  however,  in  the  cases  where  the  cerebrum  remained 
uninjured :  is  not  that  a  fact  worthy  of  attention  ?"  Any  comment  upon 
this  circumstance  in  the  present  state  of  our  knowledge  would  be  pre- 

»  Journal  de  Physiologic,  1822-23.  f  Op.  cit.,  Part  I.  p.  201. 


SANGUINEOUS    APOPLEXY.  385 

mature.  We  would  only  beseech  pathologists  to  pay  particular  atten- 
tion to  the  fact,  and  in  the  first  instance  endeavor  to  ascertain  whether 
matters  invariably  fall  out  as  they  are  reported  to  have  done  in  the  cases 
related  by  the  learned  and  very  candid  author  above  quoted. 

Abercrombie*  quotes  a  curious  case  from  Morgagni,  in  which  scirrhus 
of  the  left  lobe  of  the  cerebellum  was  followed  by  paralysis  of  the  lower 
extremities,  the  upper  being  left  perfectly  sound. 

Portal,  when  treating  of  paralysis  produced  by  lesions  of  the  cerebel- 
lum, says:  "  In  some  cases  of  injuries  of  the  cerebellum,  the  paralysis 
and  the  convulsions  have  happened  on  the  wounded,  and  riot  on  the 
opposite  side,  as  is  usually  the  case  in  patients  whose  cerebrum  has  been 
wounded  ;  but  still  this  is  not  sufficiently  proved  to  be  received  as  a 
demonstrated  point  of  doctrine." 

Among  the  anomalous  instances  of  disease  of  the  cerebellum  produc- 
ing no  symptoms  of  paralysis,  I  may  relate  one  mentioned  by  Douglas. f 
The  patient  had  been  for  three  months  affected  with  pain  in  the  fore- 
head, which  generally  obliged  him  to  sit  with  his  head  leaning  forward  ; 
he  had  little  appetite,  and  his  sleep  was  disturbed  ;  but  no  other  symp- 
tom of  disease.  He  died  suddenly  from  an  attack  resembling  syncope, 
having  been  for  a  day  much  better,  with  a  good  appetite,  and  enjoying 
quiet  sleep.  An  encysted  abscess  was  found  in  the  middle  of  the  cere- 
bellum, and  a  rupture  of  the  left  lateral  sinus,  which  probably  was  the 
immediate  cause  of  death. 

I  will  conclude  these  observations  on  sanguineous  apoplexy  with  a 
quotation  from  Dr.  Bright's  admirable  work. 

Dr.  Bright^  says :  "  When  the  decided  attack  has  taken  place,  it 
varies  greatly  in  extent  and  severity ;  sometimes  it  is  attended  with 
violent  pain  in  the  head  ;  sometimes  there  is  not  the  slightest  pain  ; 
sometimes  it  assumes  the  form  of  complete  apoplexy,  the  annihilation  of 
all  consciousness,  the  extinction  of  all  sensation,  the  loss  of  all  voluntary 
motion  ;  for  a  few  minutes,  or  a  few  hours,  the  retarded  pulse  bespeaks 
the  difficulty  with  which  the  heart  and  arteries  maintain,  by  their  volun- 
tary actions,  the  labor  of  circulation,  and  the  stertorous  sound  of  impeded 
breathing  betrays  the  inactive  condition  of  those  muscular  parts  through 
which  the  involuntary  powers  are  called  upon  to  force  the  air  in  the  pro- 
cess of  respiration,  and  these  soon  prove  insufficient  to  maintain  life.  At 
other  times,  the  apoplectic  condition,  though  well  marked,  gradually 
subsides,  or  frequently  the  state  of  insensibility  continues  for  a  few  mi- 
nutes only;  while  in  some  attacks  the  consciousness  is  never  destroyed. 

"  But  though  the  apoplectic  state  should  not  exist,  or  though  the  con- 
sciousness should  have  returned,  yet,  if  effusion  of  blood  have  taken 
place,  paralysis  will  generally  remain.  The  extent  of  this  paralysis  will 
vary  almost  indefinitely;  it  frequently  affects  both  the  motion  and  the 
sensation  of  the  same  part;  sometimes,  however,  the  motion,  and  some- 
times the  sensation,  suffers  in  the  greatest  degree;  and,  occasionally, 
the  sensation  of  one  part  and  the  motion  of  another  are  more  strikingly 
influenced. 

"  Hemiplegia  is  by  far  the  most  common  form  which  paralysis  assumes 

*  P.  470.  t  Quoted  by  Abercrombie,  129.  $  Op.  cit.,  p.  3£7.  . 

25 


386  HUMAN   BRAIN. 

from  effusion  of  blood  within  the  cranium.  I  ha.ve,  indeed,  never  met 
with  a  decided  instance  of  paraplegia  from  this  cause  ;  occasionally  one 
leg  or  arm  will  be  affected,  without  the  other  limb  on  the  same  side 
suffering  materially ;  but  those  forms  of  paralysis  which  occupy,  almost 
exclusively,  the  two  upper  or  two  lower  extremities  very  rarely  result 
from  the  sudden  effusion  of  blood  in  the  brain.  Cases  occur,  where 
paralysis  of  the  two  lower  extremities  has  appeared  to  depend  on  other 
disease  or  injury  in  the  brain;  but  of  these  we  should  always  be  some- 
what skeptical,  from  the  obvious  sources  of  error  to  which  they  are  lia- 
ble, amongst  which  the  unobserved  or  the  unsought  diseases  of  the  spinal 
cord  and  its  membranes  are  the  most  to  be  suspected.  Defective  articu- 
lation and  deglutition,  either  alone  or  as  attendants  upon  hemiplegia, 
are  likewise  common  results  of  apoplectic  seizures.  Occasionally  great 
pain  is  experienced  in  the  affected  limbs,  while  at  other  times  a  sense  of 
numbness  alone  is  felt.  The  powers  of  the  mind  generally  suffer  in  some 
degree,  but  this  varies  greatly  ;  sometimes  the  mind  evinces  great  irrita- 
bility, and  sometimes  a  childish  tendency  to  excitement,  and  a  trifling 
turn  quite  inconsistent  with  the  former  disposition,  or  with  the  present 
situation,  of  the  sufferer:  at  other  times,  the  patient  falls  into  a  dull 
state  of  imbecility — while  cases  occur  in  which  the  affection  of  the  mind 
is  so  slight,  that  it  is  only  by  close  examination  it  can  be  detected." 

"  The  successive  changes,"  says  Dr.  Bright,*  "  which  take  place  in 
the  effused  blood,  and  in  the  portion  of  the  brain  injured  by  the  effusion, 
will  of  course  depend  in  a  great  degree  upon  the  concomitant  circum- 
stances of  the  patient.  In  some  cases  no  effort  at  repair  or  restoration 
will  be  made,  but  the  surrounding  parts  will  gradually  soften  down  ; 
and  even  though  there  is  no  tendency  to  continued  haemorrhage,  the 
mischief  will  increase,  till,  some  more  extensive  effusion  occurring,  the 
disease  proves  fatal.  In  other  cases,  the  mingled  mass  of  blood  and 
comminuted  brain  will  remain  for  many  months,  forming  a  soft  mass, 
-without  there  being  apparently  sufficient  power  in  the  constitution  to 
produce  either  absorption  or  repair.  In  other  cases,  it  seems  as  if  all 
the  injured  portions  of  brain  separated,  and  a  smooth  surface  formed, 
with  more  or  less  vascularity,  derived  partly  from  the  natural  vessels  of 
the  brain,  and  partly  from  newly-formed  vessels,  and  thus  gradually  a 
kind  of  cyst  is  generated  as  a  lining  to  the  cavity  produced  by  the  clot. 
Then  a  process  of  contraction  and  absorption  goes  on,  till,  according 
probably  to  the  greater  or  less  powers  of  the  constitution  and  the  admix- 
ture of  cerebral  matter  with  the  blood  effused,  either  a  small  quantity  of 
watery  fluid  remains,  and,  this  diminishing,  the  walls  of  the  cavity  at 
length  coalesce,  or  a  more  solid  yellowish-white  substance  interposes, 
forming  a  permanent  cicatrix  in  the  brain. 

"  The  period  of  time  which  these  different  changes  require  for  their 
completion  seems  to  vary  considerably.  In  a  case  which  proved  fatal 
on  the  sixth  day,  a  commencement  was  already  made  ;  the  greater  part 
of  the  injured  brain  appeared  to  have  separated  from  that  which  had 
suffered  less  ;  a  smooth  and  polished  surface  presented  itself  on  many 
parts  of  the  cavity,  and  the  natural  vessels  of  the  brain  appeared  to  have 

*  Op.  cit.,  p.  332. 


SEROUS    APOPLEXY.  387 

become  enlarged.  In  another  case,  on  the  tenth  day  the  clot  had  under- 
gone considerable  change  in  its  color,  and  with  the  broken  cerebral 
matter  was  separating  from  the  more  sound  brain.  But  \in  Case  138, 
though  twelve  days  had  elapsed,  no  such  favorable  change  had  taken 
place;  the  broken  surface  was  still  soft,  and  the  surrounding  brain  was 
ready  to  yield  on  every  side.  In  Case  140,  where  death  occurred  after 
twenty-three  days,  considerable  change  had  taken  place  in  the  surface 
of  the  cavity  ;  but  in  some  parts  the  proce'ss  by  which  the  injured  brain 
is  detached  was  not  completed.  In  Case  139  seven  weeks  had  passed 
between  the  effusion  and  the  death ;  and  here  a  very  distinct  lining 
membrane  had  formed  of  an  opaque  white  color,  and  so  solid  as  to  allow 
of  being  detached  from  the  surrounding  brain.  In  this  case  it  was  pecu- 
liar that  this  fine  membrane  should  have  formed,  though  the  brain  im- 
mediately exterior  to  it  was  decidedly  unhealthy  and  discolored  ;  but  it 
is  possible  that  this  might  in  part  have  depended  on  subsequent  mischief. 
In  the  same  case  a  cavity  was  discovered  of  a  date  much  prior,  no  doubt, 
to  that  I  have  been  mentioning,  containing  a  clear  fluid,  and  lined  with 
a  fine  membrane,  the  opposite  surfaces  of  which  were  beginning  to  form 
vascular  adhesions;  and  very  similar  cavities  were  found  in  the  case  of 
Saunders;  but  the  date  of  these  formations  was  likewise  doubtful.  In 
the  case  of  one  after  a  lapse  of  eleven  months,  the  small  cysts  were  formed 
of  opaque  white  substance,  and  did  not  seem  so  far  advanced  as  in  Saun- 
ders. In  case  145,  after  about  a  year,  a  cicatrix  was  formed,  a  little 
soft  in  the  centre,  but  apparently  contracted,  round  its  whole  circum- 
ference, a-nd  proceeding  to  the  obliteration  of  the  cavity.  But  in  Case 
144,  after  an  equal  period,  the  soft  and  disorganized  mass  still  showed 
no  tendency  to  undergo  a  favorable  change." 

In  many  cases  it  is  extremely  difficult  to  distinguish  between  apoplexy 
from  congestion  and  epilepsy  at  the  period  of  the  attack.  Dr.  Bright* 
remarks  on  the  "  difficulty  of  drawing  a  correct  diagnosis  between  apo- 
plexy from  congestion  and  certain  epileptic  attacks.  There  is  in  truth 
scarcely  any  precise  distinction  to  be  recognized ;  the  same  state  of  ves- 
sels apparently  inducing  both,  and  the  one  passing  imperceptibly  into 
the  other.  The  convulsive  nature  of  the  symptoms  marks  the  chief 
difference,  and  this  probably  depends  rather  on  some  original  irritability 
of  the  brain,  or  on  the  part  which  chiefly  suffers  from  congestion,  than 
on  difference  of  the  exciting  cause." 

Serous  Apoplexy. — Serous  apoplexy,  though  not  the  result  of  any  single 
condition  of  the  vascular  system  of  the  brain,  nevertheless  is  always  more 
or  less  dependent  on  general  debility,  with  local  vascular  excitement  and 
congestion  of  an  asthenic  character.  For  instance,  a  man  of  intemperate 
habits  may  get  a  blow  on  his  head,  producing  concussion  ;/  if  this  is 
judiciously  treated,  he  recovers  in  the  course  of  a  few  days.  But  sup- 
pose that  he  is  bled  largely  from  the  arm,  and  purged  freely,  the  accident 
being  treated  without  reference  to  the  habits  and  constitution  of  the 
patient,  the  result  will  almost  certainly  be  serous  apoplexy.  On  the 
other  hand,  suppose  that  he  is  stimulated,  under  the  impression  that  he 
is  sinking  from  exhaustion,  then  inflammation  of  the  brain  would  ensue. 

*  Reports  of  Medical  Cases,  vol.  ii.  p.  198. 


The  exact  treatment  in  such  a  case  must,  of  course,  depend  on  the  state 
of  the  pulse,  skin,  head,  intellect,  bowels,  &c.,  but  most  probably  a  pur- 
gative with  a  cold  lotion  to  the  head  would  be  all  that  were  required. 

The  most  unequivocal  cases  of  asthenic  serous  apoplexy  are  those 
-which  occur  from  suppresion  of  urine,  the  result  of  destructive  disease 
of  the  kidneys.  The  following  case  is  a  good  illustration  of  this  form 
of  the  disease. 

Case  67. — Frederic  Smith,  set.  29,  boot-blacker  by  trade,  was  admitted  into  St.  Thomas's 
Hospital,  January  25,  1842,  under  my  care.  On  admission,  he  was  suffering  from  suppura- 
tive  erysipelas,  of  a  low,  slow,  sluggish  character.  His  countenance  indicated  organic  dis- 
ease. He  complained  of  great  pain  in  the  bladder  and  inability  to  retain  his  urine  for  many 
minutes.  The  urine  was  pale,  with  a  whitish  sediment,  and  alkaline,  albuminous,  and  con- 
taining phosphatic  acid.  This  disease  of  the  urinary  organs  was  traced  to  an  injury  of  the 
loins,  received  on  board  a  ship,  at  the  age  of  fourteen.  Up  to  this  time  he  had  been  a  fine 
hearty  boy;  but  from  the  period  of  the  accident  he  suffered  more  or  less  from  disease  of  these 
organs.  On  his  admission,  I  ordered  him  Decoct.  Pareiraebravae^ifs. ;  Acid.  Muriat.  dil.  TT^x. 
Gin  ^iv.  daily — beef-tea,  fish.  Two  incisions  and  poultices  to  the  limb;  in  a  fortnight  the 
erysipelatous  inflammation  was  entirely  subdued,  and  the  wounds  on  the  limb  nearly  healed. 
After  a  few  more  days,  suppuration  commenced  suddenly  in  the  opposite  thigh  ;  the  follow- 
ing day,  the  13th  of  February,  this  abscess  was  opened,  and  a  large  quantity  of  thin,  ichorous 
discharge  evacuated.  From  this  day  up  to  the  second  of  April,  about  six  weeks,  the  dis- 
charge varied  a  little  from  day  to  day,  but  never  ceased  altogether. 

On  this  day,  a  little  before  midnight,  a  sudden  change  took  place.  He  had  been  talking 
to  his  mother,  quite  rationally,  and,  as  he  seemed  inclined  to  go  to  sleep,  she  left  him  to  go 
to  the  fire,  when  he  suddenly  screamed  out — Oh,  mother,  mother !  what  have  you  done  to 
my  head1?  and  he  continued  screaming  violently  for  four  hours,  that  was  until  four  in  the 
morning ;  he  then  suddenly  became  quiet,  and  remained  in  one  position  until  his  death,  which 
took  place  at  12  o'clock,  that  was  exactly  twelve  hours  from  the  seizure. 
Sectio  cadaveris. — Post-mortem — twenty-two  hours. 

Head. — Calvarium,  natural ;  dura  mater,  idem.  On  removing  the  dura  mater,  we  found, 
instead  of  the  usual  appearance  of  the  pia  mater,  the  whole  surface  of  the  brain  presenting 
a  pale  yellow  or  whitish  color,  scarcely  broken  by  even  the  larger  vessels  of  the  pia  mater, 
which,  instead  of  being  distended  with  blood,  contained  only  a  narrow  line  in  their  centre. 
The  smaller  ones  were  quite  empty.  In  three  or  four  places  there  was  a  dotted  appearance, 
caused  by  the  effusion  of  blood  in  minute  points,  about  the  size  of  a  pin's  head  This  pallor 
of  the  brain  was  partly  owing  to  the  empty  state  of  the  vessels,  and  partly  to  a  layer  of 
serum  containing  a  few  flakes  of  lymph  effused  beneath  the  tunica  arachnoidea  investiens. 
This  layer  of  serum  was  found  in  equal  quantity  at  the  base  of  the  brain.  Beneath  the  pia 
mater  there  was  a  small  deposit  of  ill-formed  curdy  pus.  This  membrane  separated  very 
readily  from  the  brain.  Cerebrum  not  quite  so  firm  as  in  health.  Cerebellum  softer  than 
cerebrum.  Hemispherical  ganglion  pale.  Fibrous  neurine  beautifully  bright  and  distinct; 
more  fluid  than  usual  in  the  ventricles. 

The  connection  of  the  tenia  semicircularis  and  anterior  extremity  of  the  peduncles  of  the 
pineal  gland,  with  the  anterior  pillar  of  the  fornix,  was  beautifully  distinct,  also  the  longi- 
tudinal fibres  of  the  septum  lucidum.  Some  imperfectly-formed  pus  in  the  pia  mater,  as  it 
passed  under  the  fornix  to  form  the  velum  interpositum. 

Thorax. — Pleural  adhesions  on  the  left  side  of  old  standing.  Gray  hepatization  of  the 
lower  lobe  of  the  same  lung:  a  small  abscess,  about  the  size  of  a  walnut,  in  the  same.  The 
rest  of  both  lungs  healthy ;  no  tubercular  deposit. 

jUbdomen. — Liver,  nutmeg  color,  no  tubercles,  colon  very  low  down,  nearly  in  the  pelvis  ; 
mesenteric  glands  large.  Chyle  vessels  very  distinct. 

Right  kidney. — Only  about  half  the  cortical  substance  remaining,  and  this  presented  the 
appearance  described  by  Dr.  Bright.  The  rest  of  the  kidney  was  occupied  with  small  cavi- 
ties, lined  by  a  distinct  membrane,  and  containing  more  or  less  tuberculous  matter.  "Renal 
pelvis  enormously  distended,  and  also  the  ureter,  which  resembled  in  appearance  and  size  a 
portion  of  contracted  small  intestine.  There  was  extensive  tuberculous  deposit  in  the  coats 
of  this  tube,  within  half  an  inch  of  its  termination  in  the  bladder,  which  must  have  rendered 
it  almost  impervious. 

Left  kidney  was  entirely  disorganized,  not  a  fraction  of  its  proper  substance  remaining;  it 
consisted  of  cysts  or  cells  of  various  sizes,  lined  by  a  membrane,  the  smaller  containing 
tuberculous  matter,  and  the  larger  thick  serum,  with  flakes  of  lymph  and  pus.  Ureter  and 
pelvis  natural  size.  Bladder  contracted  j  lining  membrane,  dark  grayish  color,  but  not  rough 


SEROUS    APOPLEXY.  389 

or  thickened;  openings  of  the  prostatic  ducts  extremely  large,  about  the  size  of  swan  shot, 
or  small  peas.  The  right  lobe  of  the  prostate  entirely  disorganized,  converted  into  a  series 
of  cells,  communicating  freely,  about  the  size  of  peas;  the  left  natural. 

I  have  no  doubt  that  severe  mental  exertion  carried  on  in  an  exhausted 
system  will  sometimes  lead  to  sudden  serous  effusion.  In  these  cases 
very  decided  treatment  is  required  to  arrest  it.  Premonitory  symptoms 
always  exist  in  these  cases,  but  they  are  not  observed  by  unprofessional 
friends,  and  the  medical  attendant  is  frequently  not  called  in  until  it  is 
too  late. 

The  following  case,  to  which  I  was  called  by  my  colleague,  Dr.  Brodie 
Sewell,  and  which  I  give  in  his  own  words,  illustrates  what  I  mean  ;  and 
though  I  have  no  post-mortem  appearance  to  adduce  in  proof  of  the  posi- 
tive pathological  condition  in  this  case,  I  think  no  one  will  dispute  the 
existence  of  serous  effusion.  My  chief  reasons  for  considering  the  attack 
inflammatory,  though  accompanied  with  great  want  of  power,  were,  1st. 
The  exciting  cause,  excessive  use  of  the  organ,  and  therefore  neces- 
sarily excessive  sanguineous  stimulation;  2d.  The  heat  of  the  head. 
Nevertheless,  if  this  patient  had  been  bled  to  any  extent  in  the  first 
instance,  he  would  have  sunk  immediately.  The  diffusible  stimulus 
which  was  given  was  the  best  thing,  and  it  kept  the  flame  in  until  the 
mercury  arrested  the  asthenic  inflammatory  action,  and  caused  the  ab- 
sorption of  the  fluid. 

Case  68. — J.  B.,  set.  20,  of  an  excitable  disposition,  spare  habit,  ordinary  good  health,  though 
suffering  occasionally  from  severe  headache,  was  seized  on  the  llth  of  November,  1844, 
under  the  following  circumstances : — 

He  had  for  many  weeks  been  studying  very  closely,  without  attention  to  the  regularity  of 
the  animal  functions;  returning  after  a  long  abstinence  to  a  hearty  meal,  and  applying  closely 
during  the  greater  part  of  the  night.  He  had  not  been  to  bed  on  the  night  of  the  10th. 

Complaining  of  headache  after  dinner  on  the  llth,  he  was  persuaded  to  go  out  for  a  little 
time  instead  of  reading.  He  left  home  for  this  purpose,  and  was  brought  back  in  about  ten 
minutes  by  a  gentleman,  who  saw  him  stagger  and  fall.  He  was  tlfen  sufficiently  sensible 
to  state  somewhat  unconnected  I  y,  that  he  had  previously  felt  dizzy,  and  that  he  recollected 
falling.  This  amount  of  intelligence  was,  however,  quickly  annihilated,  as,  when  I  saw 
him,  he  was  in  a  state  of  complete  coma.  The  pulse  scarcely  perceptible,  the  extremities 
cold,  and, the  pupils  perfectly  insensible  to  light.  The  breathing  regular,  without  noise;  no 
vomiting.  I  ordered  him  a  mixture  of  ether  and  ammonia,  with  hot  applications  to  the 
extremities. 

Three  hours  afterwards,  a  slight  reaction  had  taken  place,  there  being  fuller  and  quicker 
pulse ;  the  extremities  had  recovered  their  natural  temperature,  but  the  symptoms  of  pres- 
sure on  the  brain  still  continued  undiminished,  and  the  head  was  very  hot.  I  then  ordered 
the  head  to  be  shaved,  two  leeches  to  be  applied  to  the  temples,  and  a  blister  to  the  neck, 
with  three  grains  of  calomel  laid  on  the  tongue  every  three  hours. 

Nov.  12. — No  improvement  has  taken  place;  the  patient  lies  in  the  same  state;  the  blister 
rose  without  exciting  any  apparent  sensation ;  he  passed  water  once  in  the  bed  ;  no  action 
of  the  bowels;  the  extremities  become  rapidly  cold  if  exposed.  This  morning  Mr.  Solly 
saw  him  with  me.  He  approved  of  the  general  plan  of  treatment,  but  thought  it  had  not 
been  carried  out  sufficiently. 

Ordered  gr.  v.  of  Cal.  every  hour;  cold  application  to  the  head.  This  was  continued 
without  intermission,  until  the  morning  of  the  13th,  when  Mr.  Solly  saw  him  again.  A  slight 
improvement  was  evident ;  the  pupils  were  somewhat  contracted ;  he  evinced  impatience 
when  the  powder  was  placed  in  his  mouth,  and  he  swallowed  a  little  beef-tea.  The  same 
treatment  was  continued,  and,  towards  evening,  he  was  more  restless  and  uneasy,  and  be- 
came conscious  of  the  soreness  of  his  gums  and  neck;  at  least,  he  frequently  raised  his 
hands  to  his  mouth,  and  moved  his  neck  upon  the  pillow. 

Nov.  14. — Mr.  Solly  saw  him  again  with  rne,  and  pronounced  him  much  better:  slight 
consciousness  of  person  and  place;  sight  impaired,  and  eye  wild,  but  pupil  much  more 
active.  Gums  touched,  but  no  great  amount  of  salivation.  Calomel  every  four  hours,  and 
a  dose  of  castor  oil  as  the  bowels  had  not  acted.  During  the  night  of  the  13th,  first  cognizant 
of  desire  to  pass  water. 


390  HUMAN    BRAIN. 

Nov.  15. — Mr.  Solly  saw  him  for  the  last  time;  nearly  all  the  symptoms  of  pressure 
having  been  removed.  As  most  probably,  however,  some  effusion  might  remain,  he  was 
ordered  five  minims  of  Tinct.  Canth.  in  a  mixture,  with  some  Liq.  potasses.  This  was 
continued,  with  such  modification  as  circumstances  required,  vintil  he  was  perfectly  con 
valescent;  and  he  was  able  to  resume  his  studies  after  the  Christmas  vacation. 

Simple  Apoplexy. — Dr.  Abercrombie  classifies  under  a  distinct  head, 
that  of  simple  apoplexy,  those  cases  which  occur  and  terminate  fatally, 
without  leaving  any  morbid  appearance  in  the  brain.  These  cases  are 
peculiarly  interesting  and  instructive,  but  I  think  not  so  inexplicable  as 
some  have  supposed.  I  quite  agree  with  Dr.  Burrowes  in  attributing 
the  fatal  result  to  pressure  on  the  brain  from  distended  vessels,  brought 
on  by  determination  of  blood  to  the  part,  or  by  detention  of  blood  there. 
u  But,  if  this  be  the  correct  explanation  of  the  production  of  these  cases," 
says  the  same  author,  u  why  does  the  coma  persist,  and  death  so  speedily 
ensue,  although  the  vascular  distention,  the  supposed  cause  of  pressure, 
is  removed  by  abstraction  of  blood,  or  other  remedies,  and,  as  we  ascer- 
tain after  death,  the  brain  has  sustained  no  structural  lesion  ?" 

He  ascribes  the  fatal  event  to  another  cause.  He  considers  that  from 
the  partial  arrest  of  the  respiratory  function,  the  substance  of  the  brain 
is  gradually  saturated  with  undecarbonized  blood.  The  apoplectic  per- 
son remains  in  a  condition  analogous  to  that  of  one  whose  rima  glottidis 
is  constricted,  or  who  has  been  suffering  from  asphyxia  for  some  time. 
The  apoplectic  patient  dying,  not  simply  from  pressure  on  the  brain,  but 
from  the  effects  of  imperfect  respiration,  the  presence  of  undecarbonized 
blood  in  the  brain  and  other  organs. 

Even  in  those  cases  which  terminate  fatally,  and  serum  or  blood  are 
found  effused  within  the  cranium,  Dr.  Burrows  attributes  the  coma  to 
the  state  of  congestion  which  precedes  the  effusion,  and  not  to  the  effu- 
sion itself.  "  I  am  of  opinion,  that  apoplectic  coma  is  rarely  dependent 
upon  the  extravasation  of  blood,  although  the  concomitant  paralysis  un- 
doubtedly is.  Upon  the  examination  of  the  brains  of  apoplectic  patients, 
we  sometimes  find  large  extravasations  of  blood,  which,  from  peculiar 
appearances  in  the  clot,  we  feel  assured  have  existed  there  for  many 
days,  or  even  weeks,  and  yet,  during  the  greater  part  of  that  period, 
there  has  been  no  coma.  Upon  other  occasions  we  discover  small  ex- 
travasations of  blood  within  the  brain,  which,  from  their  ^appearance, 
we  can  decide  have  only  been  effused  a  short  time  prior  to  death,  and, 
nevertheless,  there  has  been  a  well-marked  coma  in  these  cases.  Hence, 
if  pressure  be  regarded  as  the  physical  cause  of  apoplectic  coma,  and 
that  pressure  is  supposed  to  be  occasioned  by  the  extravasated  blood, 
then  we  must  account  for  the  paradox  of  a  small  extravasation  producing 
a  coma  which  terminates  fatally,  and  a  large  effusion  of  blood  having  no 
such  effect."* 

Dr.  Alisonf  considers  that  the  cause  of  simple  apoplexy  "  is  the  pres- 
sure exerted  on  the  brain  by  an  increased  propulsion  of  blood  upon  it, 
or  transmission  of  blood  through  it." 

The  following  case,  for  which  I  am  indebted  to  Mr.  Adams,  Curator 
of  the  Museum  at  St.  Thomas's  Hospital,  illustrates  well  the  form  of 
simple  apoplexy,  and  it  confirms  the  opinion  that  the  symptoms  arise 
from  pressure,  occasioned  by  turgid  vessels. 

*  P.  92,  op.  cit.  t  P-  692- 


SIMPLE    APOPLEXY.  391 

Case  69.— James  Bibby,  set.  38,  a  man  of  intemperate  habits,  thoush  generally  enjoying 
good  health  ;  for  twenty-three  years  in  the  service  of  Mr.  Whitfield.  He  had  had  two  slight 
apoplectic  fits;  one  about  two  years,  and  the  other  a  few  months,  previous  to  his  last  illness. 
On  the  morning  of  the  7th  December,  1845,  he  complained  of  fullness  arid  pain  in  his  head, 
and  appeared  dull  and  heavy;  about  10  A.  M.  he  suddenly  fell  down  in  a  fit,  his  head  came 
in  contact  with  a  piece  of  stone,  by  which  the  temporal  artery  was  wounded,  and  he  lost  a 
large  quantity  of  blood  before  any  assistance  was  rendered;  when  picked  up,  he  was  per- 
fectly insensible,  with  extremely  labored  and  slightly  stertorous  breathing;  he  remained  in 
this  condition  for  about  twenty  minutes,  when  consciousness  began  to  return,  and  he  after- 
wards completely  regained  his  senses;  no  paralysis  followed  this  fit.  A  purgative  dose  of 
calomel  and  colocynth  was  given ;  head  shaved,  and  counter  irritation  applied. 

On  the  following  day,  the  8th  December,  he  became  restless  and  wandering,  and  was 
allowed  a  small  quantity  of  gin. 

On  the  9th  December,  fte  restlessness  and  wandering  were  increased,  and  he  became 
extremely  violent;  his  symptoms  resembling  those  of  delirium  tremens ;  gin,  morphia,  and 
ammonia,  with  sulphuric  ether,  were  given.  He  continued  in  the  same  state  till  6  p.  M., 
when  he  suddenly  became  perfectly  quiet,  the  pupils  fixed,  breathing  stertorous,  pulse  slow, 
full,  and  labored,  and  had  the  ordinary  appearance  of  a  man  in  an  apoplectic  fit;  in  this 
condition  he  remained  till  11  p.  M.,  when  he  died;  five  hours  from  the  appearance  of  the 
apoplectic  symptoms. 

At  the  post-mortem  inspection,  on  the  10th  December,  the  only  morbid  appearance  found, 
was  an  extremely  congested  condition  of  the  vessels  of  the  membranes  and  substance  of  the 
brain,  with  a  slight  serous  effusion  beneath  the  arachnoid  over  either  hemisphere.  The  tho- 
racic and  abdominal  viscera  were  generally  healthy. 

Andral  believes  in  the  existence  of  this  congestive  apoplexy,  and  re- 
lates the  following  very  interesting  case,  which  also  throws  some  light 
on  the  pathology  of  serous  apoplexy  :* — 

Case  70. — A  woman,  fifty  one  years  old,  of  a  sanguine  temperament,  and  strong  constitu- 
tion, ceased  to  menstruate  about  her  forty-ninth  year;  during  the  six  months  following  she 
was  subject  to  numbness  in  the  right  arm.  In  her  fifty-first  year  she  suddenly  lost  con- 
sciousness, fell,  and  retained,  when  she  came  to  herself,  some  difficulty  in  her  speech,  with 
some  falling  of  the  commissure  of  the  lips  arid  tongue  on  the  right  side;  considerable  dimi- 
nution of  motion  and  sensation  of  this  side,  nausea  and  bilious  vomiting.  Under  proper 
treatment  this  state  disappeared  at  the  end  of  four  weeks.  After  this  the  patient  returned 
to  a  perfect  state  of  health,  when,  towards  the  middle  of  March,  1819,  she  again  began  to 
feel  a  little  weakness  in  the  right  arm;  slight  pains  of  head  in  the  frontal  region  soon  super- 
vened, and  on  the  20th  of  April,  without  any  obvious  cause,  there  came  on  in  the  night, 
during  sleep,  a  new  attack,  more  violent  than  the  former,  and  of  the  same  side,  total  loss  of 
speech,  considerable  diminution  of  sensibility,  but  particularly  of  motion  of  extremities  of 
right  side;  features  not  altered;  tongue  fell  a  little  on  right  side.  This  new  attack  disap- 
peared, however,  more  promptly  than  the  preceding;  and  at  the  end  of  three  days,  the 
patient  having  entered  the  hospital,  presented  the  following  state : — She  had  slept  well  the 
previous  night;  some  weight  of  head;  tongue  unsteady  when  she  put  it  out;  some  numb- 
ness and  weakness  on  the  right  side  of  the  body;  speaks  distinctly;  pulse  full,  strong,  and 
slow;  habitual  constipation  (lemonade,  with  cream  of  tartar)  ;  fifteen  leeches  to  each  foot; 
warm  pediluvium,  purgative  lavement.  In  the  morning  she  took  some  soup,  and  was  seized 
with  vomiting  in  the  course  of  the  day,  when  she  threw  up  some  bile;  the  vomiting  brought 
on  a  new  attack,  followed  by  hemiplegia  on  the  right  side,  and  greater  embarrassment  of 
speech.  She  was  bled  to  ten  ounces;  new  attacks  of  a  slight  nature  appeared  in  the  night, 
upon  which  sinapisms  were  applied  to  the  feet ;  after  this  the  fteces  passed  involuntarily.  On 
the  30th,  hemiplegia  more  developed ;  articulation  nearly  impossible ;  pulse  less  full,  less 
hard,  and  more  accelerated;  paralysis  of  the  bladder  (lemonade,  with  one  ounce  of  soluble 
tartar,  bleeding  from  the  jugular  vein,  purgative  lavement;  introduction  of  the  catheter.) 
Immediately  after  the  bleeding  (ten  ounces)  a  new  attack,  followed  by  total  loss  of  speech, 
and  of  motion  in  the  right  extremities,  frothing  at  the  mouth,  dilatation  of  the  pupil,  counte- 
nance quite  vacant.  On  the  following  morning  these  symptoms  were  all  aggravated ;  trismus 
supervened,  which  prevented  her  from  drinking,  and  constant  drowsiness.  On  the  1st  of 
May,  pupils  immovable,  blindness,  trismus,  frothing  at  the  mouth  at  each  expiration,  con- 
tractility abolished  on  the  right  side,  almost  none  on  the  left,  a  little  sensibility  on  both  sides, 
rather  more  on  the  left:  pulse  full,  hard,  irregular  for  the  number  of  pulsations  (twenty- 
leeches  to  the  neck,  blister  to  legs,  purg.  lavements).  She  died  a  little  after  the  visit. 


*  Andral,  op.  cit.,  p.  24. 


392  HUMAN    BRAIN. 

Post-mortem. — Cranium. — The  lateral  ventricles  contained  nearly  four  ounces  of  limpid 
serum;  no  lesion  in  the  thoracic  or  abdominal  viscera. 

Remarks. — The  apoplectic  attacks  in  this  case  seem  to  have  been  caused  by  simple  san- 
guineous congestions  in  the  brain.  It  would  appear  that  here  the  hemiplegia  was  the  re- 
sult of  a  sanguineous  congestion,  greater  in  one  hemisphere  than  in  the  other,  whereby  thia 
hemisphere  lost  its  influence  over  the  muscular  contractility,  even  when  the  congestion 
ceased  to  exist.  The  first  time,  the  hemiplegia  was  preceded  by  a  total  loss  of  conscious- 
ness ;  the  second  time,  it  was  gradual,  and  not  announced  by  any  symptom  of  apoplectic 
attack.  The  more  alarming  symptoms  observed  for  the  last  two  days  were  the  resvflt  of 
serous  effusion  into  the  ventricles  ;  of  which  the  habitual  sanguineous  congestion  had  been 
probably  a  predisposing  cause.  We  should  not  forget  to  notice  here  the  influence  of  the 
vomiting  on  increasing  the  hemiplegia. 

The  following  graphic  account,  derived  from^he  Madras  Journal, 
edited  by  my  old  fellow-apprentice,  Samuel  Rogers,  is  interesting  in 
many  points  of  view  ;  and  while  it  strikingly  illustrates  the  value  of  cold 
effusion  as  a  therapeutical  agent  in  cerebral  affections,  it  presents  many 
facts  highly  instructive  both  physiologically  and  practically.  After  de- 
scribing the  circumstances  under  which  the  march  was  undertaken,  and 
their  exposure  to  the  sun,  the  report  goes  on  to  say,*  "  About  eight 
o'clock  a  most  melancholy  scene  commenced ;  men  were  seen  to  drop 
down  and  instantly  expire ;  others  less  severely  attacked  were  saved  by 
timely  and  copious  bleeding.  Every  hour  added  to  our  melancholy 
situation;  for  notwithstanding  our  utmost  exertions  the  day  ended,  I 
regret  to  say,  with  no  less  a  loss  than  eighteen,  and  left  us  with  sixty- 
three  sick  in  the  hospital.  Our  loss  on  this  occasion,  with  one  excep- 
tion, was  entirely  confined  to  the  recruits,  and  the  chief  part  of  the  sick- 
ness that  followed  was  also  confined  to  them.  The  troops  halted  one 
day,  and  on  the  following  day  they  lost  three  more. 

"  When  warning  of  the  attack  was  given  to  the  patients,  they  usually 
complained  of  difficult  breathing,  with  a  sense  of  tightness  and  oppres- 
sion about  the  chest,  followed  by  giddiness,  burning  heat  of  the  eyes, 
and  a  sense  of  general  fullness  about  the  head,  in  many  amounting  to 
excruciating  pain,  succeeded  by  loss  of  sense  and  motion,  faltering  of 
the  tongue  on  attempting  to  speak,  fullness  of  the  eyes,  dilated  and  fixed 
pupils,  violent  twitching  of  the  muscles  of  the  face,  particularly  those 
about  the  mouth,  subsultus  tendinum,  and  involuntary  stools.  Along 
with  these  symptoms,  the  patients  also  had  a  strong,  full,  and  frequent 
pulse,  tremendous  throbbing  of  the  carotid  and  temporal  arteries,  flushed, 
swollen,  and  sometimes  livid  countenance,  and,  throughout,  a  parched 
and  burning  skin. 

"  In  so  severe  a  form  of  disease,  I  could  only  look  for  success  from 
immediate  and  profuse  depletion  ;  blood  was  accordingly  abstracted 
from  different  assailable  points,  viz.,  the  arm,  the  jugular  vein,  and  the 
temporal  artery.  Cold  was  applied  to  the  head,  and  at  the  same  time 
the  feet  were  immersed  in  hot  water.  Blisters  were  applied  to  the  head, 
neck,  and  lower  extremities;  brisk  purgatives  were  administered,  and 
their  operation  assisted  by  purgative  injections.  When  the  disease 
terminated  in  fever,  the  rest  of  the  treatment  consisted  chiefly  in  small 
doses  of  calomel  and  antimony.  In  several  of  the  cases  spontaneous 
vomiting  took  place,  without  producing  any  marked  effect.  No  case  of 
paralysis  supervened. 

*  Madras  Journal,  vol.  ii.  p.  326. 


TREATMENT    OF    PREMONITORY    SYMPTOMS.  393 

"  I  have  to  regret  that  the  situation  of  the  corps  at  the  time,  and  the 
severe  duties  I  had  to  perform,  rendered  it  impossible  for  me  to  examine 
any  of  the  bodies  after  death. 

"  Considering  the  foregoing  details  of  this  affection,  the  full,  quick 
pulse,  the  great  heat  of  skin,  the  violence,  suddenness,  and  urgency  of 
the  symptoms,  venas  sectio  seemed  at  once  indicated,  and  it  was  carried 
ad  deliquium,  or  to  the  relieving  the  patient.  It  was  found  that  it  some- 
times required  fifty,  sixty,  nay,  even  one  hundred  ounces  of  blood  to 
produce  this  effect ;  and  that  the  remedy  sometimes  was  worse  than  the 
malady;  for,  though  the  first  attack  might  be  relieved,  yet  the  subsequent 
symptoms  required  the  same  profuse  evacuation  for  their  relief;  and  from 
the  previous  loss  of  blood  the  patient  was  not  in  a  state  to  bear  such 
depletion.  In  fact,  two  individuals  became  convulsed,  and,  shortly 
after  they  were  bled,  died;  and  after  death  it  was  found,  that  although 
the  heart  was  empty,  the  vessels  of  the  head  were  loaded  with  blood. 
This  clearly  indicated  that  whatever  it  was  that  excited  the  heart's  inor- 
dinate action,  blood-letting  would  not  subdue  it;  for  as  long  as  a  drop 
of  blood  remained  it  was  sent  to  the  head.  How  lucky  for  us,  and 
truly  so  for  our  patients,  that  we  found  in  the  cold  effusion  a  most  effect- 
ual remedy!  Just  as  one  man  had  expired,  I  might  almost  say  under 
the  lancet,  another  was  brought  into  hospital.  He  was  put  into  the 
bathing  tub,  and  a  constant  stream  of  cold  water  poured  on  his  head  till 
he  felt  relieved.  He  was  then  put  into  bed,  calomel  9i.  given  to  him, 
his  head  shaved,  and  cold  wet  cloths  kept  to  it;  and,  in  a  few  minutes 
after,  as  the  heat  returned,  and  the  pulse  rose,  forty  ounces  of  blood 
were  taken  from  his  arm.  He  was  by  these  means  perfectly  relieved, 
and  fell  asleep  ;  and  as  often  as  the  pain  and  heat  returned  was  the  cold 
effusion  had  recourse  to.  This,  with  purgatives,  leeches  to  the  tem- 
ples, and  cold  cloths  to  the  head,  cured  him,  as  well  as  all  the  subse- 
quent cases,  when  the  men  came  into  hospital  in  proper  time,  and  the 
disease  had  not  advanced  too  far. 

"  The  history  of  the  first  person  in  whom  the  cold  effusion  was  had 
recourse  to  as  the  principal  remedial  agent,  would  be  but  the  history  of 
all  the  subsequent  cases.  Some  men  required  two  or  three  bleedings, 
but  they  were  not  large,  and  we  now  found  convalescence  speedy ; 
whereas,  in  the  former  cases  that  recovered,  it  was  imperfect,  uncertain, 
and  protracted.  The  benefit  of  the  cold  effusion  has  brought  to  my  re- 
collection the  advantages  I  formerly  derived  on  the  line  of  march  with 
the  left  wing  of  H.  M.  13th  Light  Infantry,  from  frequently  pouring 
water  on  the  men's  heads  when  they  felt  oppressed  ;  than  which,  nothing 
seemed  to  allay  arterial  action  and  nervous  excitement  so  well ;  and  so 
grateful  was  it  to  the  men's  feelings,  that  they  used  to  get  it  two  or  three 
times  in  the  course  of  the  hour,  at  their  own  solicitation.  It  allayed  the 
heat  and  thirst,  and  procured  sleep." 

Treatment  of  the  Premonitory  Syntptoms. — Though  it  is  not  possible  to 
say  a  great  deal  on  this  subject,  inasmuch  as  each  individual  case  will 
vapy  more  or  less,  and  must  be  treated  on  its  own  merits,  or  according 
to  the  circumstances  which  arise,  and  for  the  very  reason  that  it  is  im- 
possible to  lay  down  very  precise  rules  to  guide  the  practitioner  in  all 
instances,  it  behoves  him  to  bring  all  his  powers  of  mind  to  judge  and 


394  HUMAN    BRAIN. 

discriminate  between  those  symptoms  which  really  threaten  a  coming 
storm,  and  those  which  arise  from  some  temporary  disturbing  cause. 
There  is  no  disease  in  which  judicious  medical  advice  may  be  of  more 
service  than  in  threatened  apoplexy.  It  is  the  duty  of  every  medical 
man  to  warn  the  friends  of  a  patient  rather  than  the  patient  himself,  of 
those  circumstances  which  might  induce  a  fit  of  apoplexy  in  a  form  pre- 
disposed by  disease  to  its  occurrence.  It  is  true  that  in  many  cases  this 
is  not  possible  ;  but  when  an  attack  has  once  occurred,  then  the  medical 
man  has  it  in  his  power  to  speak  officially.  In  all  cases  the  condition 
of  the  digestive  organs  must  be  attended  to,  especially  the  state  of  the 
hepatic  circulation.  All  tendency  to  obesity  should  be  corrected.  A 
fat  belly  encroaches  on  the  chest  and  interferes  with  the  organs  of  res- 
piration and  circulation.  But  this  must  not  be  attempted  rudely  ;  habits 
that  have  been  long  established  must  not  be  suddenly  changed.  Violent 
exercise  must  be  especially  avoided.  Moderate  exercise,  but  plenty  of 
it — moderate  quantity  of  food,  and  that  very  simple — moderation  in  the 
use  of  stimulants,  if  they  have  been  freely  used  habitually.  The  entire 
abandonment  ought  to  be  ultimately  aimed  at.  If  the  tendency  is  very 
decided,  and  the  threatening  of  an  attack  very  strong,  then  all  mental 
occupation  should  be  abstained  from,  and  the  patient  live  a  completely 
vegetative  life.  I  sometimes  say  to  my  patients,  "  You  must  be  con- 
tented to  live  the  life  of  a  cabbage."  A  mild  aperient  should  be  given 
every  night  to  prevent  any  straining  at  stool,  which  is  in  itself  most  dan- 
gerous, and  all  patients  should  be  warned  against  it.  If  there  is  the 
least  appearance  of  bronchial  disease,  it  should  be  treated  decidedly 
and  promptly  by  counter-irritation  to  the  chest,  and  expectorants  and 
mild  sedatives.  Congested  lungs  delay  the  blood  on  the  right  side  of 
the  heart,  and  this  affects  more  or  less  the  whole  venous  system,  but 
especially  the  jugular  veins  and  cranial  sinuses.  But  the  very  act  of 
coughing  affects  the  cerebral  circulation,  and  apoplectic  effusion  has 
occurred  during  its  paroxysms.  Dr.  Watson  mentions  that  a  patient  of 
his  died  from  an  apoplectic  fit  induced  by  straining  in  pulling  on  a  wet 
boot.  Loud  talking,  playing  on  wind  instruments,  singing,  intemperance, 
venereal  excess,  the  depending  posture,  and  severe  cold,  are  all  referred 
to  by  this  physician  as  occasionally  exciting  causes  of  apoplexy.  If  any 
discharge  has  been  suppressed,  either  it  must  be  re-established,  or  a  fresh 
artificial  one  made. 

Apoplexy. —  Treatment. — In  the  treatment  of  apoplexy,  the  first  thing 
to  determine  is  not  so  much  whether  the  effusion  is  serous  or  sanguineous, 
but  whether  it  is  of  a  sthenic  or  asthenic  character,  whether  our  patient 
will  bear  depletion,  or  whether  he  is  depressed,  and  whether  the  dis- 
ease itself  is  the  result  of  exhaustion.  With  regard  to  our  diagnosis  of 
the  seat  and  nature  of  the  effusion,  this  is  more  important  in  relation  to 
our  prognosis  of  this  disease  than  our  treatment.  I  do  not  mean  to 
undervalue  careful  diagnosis  in  thes^  cases;  on  the  contrary,  I  consider 
it  of  the  greatest  importance,  and  no  pains  can  be  too  great  which  will 
assist  us  in  coming  to  a  right  conclusion.  In  these  cases  the  friends 
are  of  course  extremely  anxious,  and  our  prognosis,  whether  favorable 
or  otherwise,  must  depend  on  the  conclusions  we  arrive  at  regarding 
the  cause,  the  seat,  and  the  nature  of  the  effusion.  If  the  cause  of  the 


TREATMENT    OF    APOPLEXY.  395 

effusion  be  extreme  plethora,  and  some  accidental  circumstance,  such 
as  posture,  or  straining  at  stool,  without  any  disease  of  heart  and  ves- 
sels, then  our  prognosis  might  be  favorable.  If  the  seat  of  the  effusion 
appears  to  be  at  the  base  of  the  brain,  but  not  near  the  medulla  oblon- 
gata,  then  it  may  possibly  be  remedial.  These  are  merely  illustrations 
of  the  fact,  that  though  our  treatment  may  be  the  same  wheresoever  the 
effusion  may  have  occurred,  and,  in  many  instances,  howsoever  it  may 
have  been  produced,  our  diagnosis  ought  yet  to  be  made  with  the  same 
care,  and  is  of  nearly  the  same  value,  as  if  the  whole  plan  of  our  treat- 
ment depended  upon  it. 

Our  remedies  in  all  cases  are  few  and  simple.  First  in  the  list  stands 
blood-letting,  the  most  valuable  remedial  agent  in  some  cases,  the  most 
dangerous  in  others.  Many  a  valuable  life  has  been  saved  by  the  prompt 
and  free  use  of  the  lancet:  more  have  been  hastened  into  eternity  by  its 
indiscriminate  employment. 

Dr.  Abercrombie,  whose  opinion  on  these  cases  is  so  valuable,  scarcely 
allows  that  there  are  any  cases  in  which  bleeding  is  not  desirable.  He 
says,*  "  In  the  extent  of  our  evacuations,  indeed,  a  due  regard  is  cer- 
tainly to  be  had  to  the  age  and  constitution  of  the  patient,  and  the 
strength  of  the  pulse;  but  I  think  we  have  sufficient  ground  for  saying, 
that  there  are  no  symptoms  which  characterize  a  distinct  class  of  apo- 
plectic affections,  requiring  any  important  distinction  in  the  treatment; 
or,  in  other  words,  a  class  which  in  their  nature  do  not  admit  of  blood- 
letting. On  this  important  point  we  may  refer  with  some  confidence  to 
the  facts  which  have  been  related.  Weakness  of  the  pulse  and  paleness 
of  the  countenance  we  have  seen  to  be  frequent  symptoms  of  the  worst 
forms  of  sanguineous  apoplexy,  and  on  the  other  hand  we  have  seen 
cases  terminate  by  serous  effusion  which  were  accompanied  by  strong 
pulse  and  flushing  of  the  countenance.  Finally,  we  have  seen  one 
remarkable  case  in  which  there  existed  every  circumstance  that  could 
lead  us  to  consider  the  disease  as  serous  apoplexy,  but  which  was  fatal 
without  any  effusion ;  and  another  in  which  there  was  most  extensive 
effusion,  without  any  apoplectic  symptom.  It  is  likewise  to  be  kept  in 
mind  that  in  apoplectic  affections  the  strength  of  the  pulse  is  a  very  un- 
certain guide,  for  nothing  is  more  common  than  to  find  it,  upon  the  first 
attack  of  apoplexy,  weak,  languid,  and  compressible,  and  becoming 
strong  and  full  after  the  brain  has  become  in  some  degree  relieved  by 
large  blood-letting. 

u  It  would  be  quite  superfluous  to  detail  common  apoplectic  cases 
treated  successfully  upon  these  principles.  But  it  may  be  of  use,  in 
connection  with  this  part  of  the  subject,  to  select  a  few  cases,  which, 
occurring  in  old  and  infirm  people,  might  have  been  considered  either 
examples  of  serous  apoplexy,  or  modifications  of  the  disease  not  admit- 
ting of  active  treatment,  yet  under  such  treatment  terminating  favorably. 

Case.  71. — "A  woman,  aged  70,  of  a  spare  habit,  and  thin,  withered  aspect,  having  walked 
out  in  her  usual  health,  fell  down  in  the  street,  speechless  and  paralytic  on  the  right  side. 
I  saw  her  four  or  five  hours  after  the  attack.  She  was  then  much  oppressed,  but  not  en- 
tirely comatose.  She  was  completely  speechless  and  paralytic:  her  pulse  about  90,  and  of 
tolerable  strength.  She  was  bled  to  15  ounces;  purgative  medicine  was  ordered,  with  col(J 


*  P.  288. 


396  HUMAN   BRAIN. 

applications  to  her  head.  On  the  following  day  she  was  considerably  improved,  both  in 
speech  and  in  the  motion  of  the  right  side;  but  having  become  rather  worse  towards  night, 
she  was  again  largely  bled,  and  purgative  medicine  was  continued.  From  this  time  she 
improved  rapidly.  At  the  end  of  the  week  she  was  able  to  walk  with  little  assistance,  and 
in  a  few  days  more  was  restored  to  perfect  health." 

At  one  time,  this  opinion  of  the  imperative  necessity  for  blood-letting 
in  apoplexy  was  almost  universal,  but  it  has  lately  been  much  modified. 

The  deservedly  high  reputation  of  Abercrombie  gave  too  much  value 
to  the  use  of  the  lancet  in  apoplexy,  and  it  will  therefore  be  well  to  turn 
to  the  opinions  of  other  observing  practitioners,  and  see  if  we  may  not 
find  a  safe  middle  path. 

Dr.  Bright's  opinion  is  decidedly  in  favor  of  blood-letting  as  the  gene- 
ral rule,  and  the  omission  of  it  should  be  the  exception.  He  concurs 
with  others  in  considering  it  our  duty  to  bleed,  and  bleed  largely,  even 
when  the  pulse  is  slow  and  laboring.  He  is  opposed  to  small  bleedings, 
as  they  only  relieve  the  heart  of  its  load,  and  enable  it  to  do  more  mis- 
chief, increasing  the  force  of  the  circulation  instead  of  diminishing  it. 
If,  after  bleeding,  the  pulse  increases  in  rapidity  and  volume,  the  lancet 
must  be  used  again.  But  if,  after  the  abstraction  of  forty  or  fifty  ounces, 
no  decided  benefit  is  gained,  then  we  must  desist. 

Dr.  Watson,  who  considers  blood-letting  our  sheet-anchor  in  certain 
forms  of  apoplexy,  carefully  distinguishing  between  those  which  require 
it  and  those  in  which  it  would  be  injurious,  also  advises,  after  one  full 
and  sufficient  bleeding  from  the  arm,  to  abstain  from  further  use  of  the 
lancet. 

Dr.  Copland  advises  a  full  blood-letting,  thirty  or  forty  ounces  at 
once,  particularly  when  the  attack  has  proceeded  from  exciting  causes, 
and  paralysis  is  not  present. 

The  pulse  is  generally  more  or  less  intermittent  and  irregular  on  the 
first  onset  of  apoplexy,  so  that  this  character  by  itself  must  not  deter  us 
from  blood-letting,  if  at  the  same  time  it  is  not  feeble,  and  thin,  and 
quick,  and  the  patient  does  not  show  other  signs  of  general  depression, 
such  as  pallid  countenance  and  cold  skin. 

The  same  observations  which  I  made  regarding  the  treatment  of  in- 
flammatory affections  of  the  brain,  apply  to  the  treatment  of  apoplexy. 
The  disease  itself  is  most  depressing,  and  in  its  treatment  we  must  not 
consider  simply  the  present  moment — we  must  look  also  to  the  future. 

We  must  not  be  satisfied  in  arresting  the  cerebral  extravasation,  but 
consider  the  possible  condition  of  the  brain  afterwards.  I  am  convinced, 
from  observation,  of  what  occurs  in  cases  of  injury  of  the  brain  as  well 
as  in  true  apoplexy,  that  large  abstraction  of  blood  gives  rise  to  serous 
effusion.  And  every  man  engaged  extensively  in  practice  in  London 
will  bear  witness  to  the  frequent  occurrence  of  delirium  tremens,  in  either 
a  slight  or  severe  form,  after  the  apoplectic  symptoms  have  been  subdued. 

The  next  case  exhibits  those  circumstances  which  indicate  the  neces- 
sity of  immediate  and  decided  blood-letting,  and  I  think  it  illustrates 
the  value  of  prompt  treatment  on  the  very  onset  of  the  apoplectic  attack. 
I  have  no  doubt  that  in  this  case  all  the  vessels  of  the  brain,  especially 
the  venous  system,  were  excessively  distended  by  blood  rushing  into 
them  in  the  stooping  posture,  and  that  if  she  had  not  been  bled  freely  at 
first,  extravasation  must  have  inevitably  occurred. 


TREATMENT   OF   APOPLEXY.  397 

I  suppose  that  the  sudden  distention  gave  rise  to  some  inflammatory 
action  which  the  mercury  and  the  leeches  arrested,  for  it  was  not  until 
the  mouth  became  sore  that  her  sufferings  were  put  an  end  to.  The 
endermic  mode  of  exhibiting  this  mineral  is  the  best  in  such  cases  where 
it  is  desirable  to  obtain  its  influence  rapidly. 

Case  72. — May  15th,  1846. — I  waS  requested  by  Mr.  Wildbore,  of  Shoreditch,  to  see  a  lady 
who  was  said  to  have  fallen  down  in  a- fit  of  apoplexy. 

The  patient,  Mrs.  T.,  40  years  of  age,  stout,  and  rather  full  habit,  temperate,  and  in  com- 
fortable circumstances  ;  she  has  had  seven  children,  the  youngest  13  months  old.  She  has 
been  under  Mr.  Wildbore's  care  occasionally  for  the  last  five  years,  with  symptoms  of  cerebral 
disease,  but  of  so  doubtful  a  character  that  a  physician  of  high  character  who  saw  her  about 
two  years  ago,  pronounced  them  merely  functional.  The  symptoms  were  varied  ;  sometimes 
she  expressed  a  feeling  of  numbness  in  her  limbs ;  sometimes  shooting  pains  in  her  head, 
and  a  feeling  of  swelling  of  the  lips,  lowness  of  spirits,  and  feeling  of  weakness. 

The  present  attack  came  on  when  she  was  stooping  to  show  her  servant  how  to  clean  the 
fire-place.  When  she  recovered  her  consciousness  she  stated  that  she  felt  a  terrific  pain  in 
the  head,  and  she  said,  UO  Caroline,  I  am  dying,  take  me  up  stairs."  When  she  was  laid 
down  on  the  bed,  she  vomited,  and  almost  immediately  afterwards  lost  her  consciousness; 
she  did  not  remain  wholly  insensible  for  a  long  period,  but  seemed  to  be  in  a  dreamy  state 
for  four  or  five  hours,  not  able  to  speak,  but  evidently  suffering  pain,  as  evinced  by  putting 
her  hand  to  her  head. 

Present  state. — I  found  her  lying  on  the  bed,  countenance  slightly  flushed.  In  answer  to 
my  question,  whether  she  felt  any  pain,  she  said.  "  Yes,  violent  pain  in  the  back  part  of  the 
head."  She  had  previously  answered  quite  rationally  some  questions  from  one  of  her 
friends ;  her  head  was  hot,  but  her  feet  cold ;  her  pupils  were  rather  contracted,  but  not  ex- 
tremely so;  they  acted  freely  to  the  light;  no  paralysis  of  either  the  face  or  the  limbs.  Pulse 
56.  and  soft.  She  had  been  bled  to  about  16  oz. :  this  I  was  informed  had  not  produced  any 
material  effect  on  the  pulse;  which  certainly  had  not  risen  in  frequency  with  it. 

Ordered  a  blister  to  be  made  with  a  hot,  metal  plate  at  the  back  of  the  neck,  to  be  dressed 
with  mercurial  ointment.  Turpentine  enema  immediately.  Liq.  hyd.  bjchlorid.  Jj.  tinct. 
lyttge,  ^ifs.  aq.  cinnamon,  ^vfs.  sumat.  cochl.  duo  magna.  6tis.  horis. 

16th,  4  P.M. — Rather  better — quite  conscious,  but  cannot  move  her  head  without  suffering 
most  violent  pain:  she  feels,  she  says,  as  if  her  head  were  being  split  open;  the  light  from 
the  window  distresses  her.  Her  stomach  is  extremely  irritable ;  vomits  almost  everything 
she  eats;  countenance  flushed.  She  says  that  the  cold  lotion  is  very  grateful  to  her,  that 
without  it  her  head  would  be  intolerable;  pulse  80.  Ord. — Cal.  gr.  £.  om.  hora.  Hirudines 
xxx.  capiti.  Leave  off  the  hyd.  biehlorid. 

17th,  10  A.M. — Has  passed  a  quiet  night,  slightly  better,  stomach  still  very  irritable,  cannot 
keep  anything  down  but  a  little  milk,  pain  in  the  head  not  quite  so  severe.  The  leeches  have 
not  bled  well  or  freely;  the  mouth  slightly  affected  with  mercury.  Ordered — Rep.  hirudines. 
Hyd.  c.  creta  gr.  ij.  6tis.  horis. 

18th. — Decidedly  better — bowels  relieved,  free  from  sickness,  much  less  pain  in  her  head; 
says  she  found  decided  relief  from  the  leeches;  mouth  sore  from  mercury.  Ordered — Leave 
off  the  mercury,  and  take  Inf.  armoracce  ^j.  Acid  hydrocyanic  dil.  TT^iv. 

19th. — She  says  she  is  not  so  well  to-day;  more  pain  in  the  head;  which  is  hotter  to  the 
touch;  she  feels  very  sinking,  she  says,  and  that  her  eyeballs  are  painful  ;  her  countenance 
is  flushed.  The  Inf  armoraca?  seems  to  have  been  too  stimulating;  ordered  to  be  cupped  to 
^vj.  and  to  take  a  saline  draught. 

20th,  9  A.M. — She  says  she  is  better — that  her  head  is  easy  when  she  is  quite  quiet,  but 
that  if  she  moves,  it  then  swims ;  the  leeches  bled  pretty  well,  and  gave  her  great  relief; 
countenance  is  still  flushed,  pulse  72,  soft,  tongue  furred,  mouth  tender  from  the  mercury, 
menses  have  appeared  very  profusely,  a  good  deal  of  pain  in  the  lower  part  of  the  belly, 
bowels  purged.  Ordered — Omit  the  last  medicine,  and  take  a  simple  effervescing  mixture. 

23d. — Going  on  well,  head  much  more  comfortable. 

She  recovered  perfectly  in  about  a  week. 

I  have  since  seen  this  patient  repeatedly,  and  she  has  had  no  return  of  the  apoplectic  attack. 
Though  always  a  temperate  person,  I  have  made  her  abstain  from  all  stimulating  liquors, 
and  take  nothing  stronger  than  water.  She  says  that  she  has  been  decidedly  more  comfort- 
able ever  since  she  adopted  this  regime. 

On  being  called  to  an  alleged  case  of  apoplexy  it  is  well  to  accompany 
your  messenger.  In  cases  of  emergency  this  is  frequently  one  of  the 
family,  and  much  valuable  information  touching  the  history  of  the  patient 


398  HUMAN    BRAIN. 

and  the  advent  of  the  attack  may  often  be  gained  before  seeing  him. 
Inquiry  should  be  made  as  to  his  age,  and  whether  triere  is  any  hereditary 
predisposition  to  the  disease;  whether  he  is  subject  to  fits,  what  are  his 
habits  of  life,  what  his  circumstances,  whether  he  has  had  cause  for 
anxiety  lately,  whether  he  has  been  harassed  in  business.  The  period 
of  day  at  which  the  attack  may  have  occurred  will  also  of  course  suggest 
questions.  As  soon  as  the  patient  is  in  our  hands,  the  neckcloth  and 
collar  should  be  loosened,  the  head  raised,  hot  water  ordered  for  the 
feet,  and  the  pulse  felt;  as  the  first  question  which  the  medical  man  has 
to  decide  is  to  bleed  or  not  to  bleed,  and  on  his  correct  decision  hangs 
the  momentous  issue  of  the  case. 

Enough  has  been  said  to  show  that  this  cannot  be  decided  by  the 
pulse  alone,  nor  by  the  countenance,  the  breathing,  or  indeed  by  the 
condition  of  any  one  organ  or  any  one  set  of  organs,  but  by  evidence 
derived  from  them  all  conjointly,  and  the  history  obtained  of  the  patient. 

The  broad  features  of  those  cases  in  which  bleeding  is  desirable  may 
thus  be  drawn,  but  the  minuter  details  must  be  left  to  the  discrimina- 
tion of  the  practitioner  at  the  time.  The  countenance  may  be  either 
pale  or  flushed,  if  the  pulse  be  strong,  slow,  full,  or  wiry.  Whatever 
the  state  of  the  pulse  is,  if  the  face  is  flushed  and  the  head  hot,  feet  cold, 
patient  under  60,  and  robust,  and  active;  and  the  attack  induced  by  ex- 
citement, whether  of  a  psychical  or  physical  nature,  whether  the  result  of 
mental  disturbance  or  stimulating  liquor. 

Bleeding  is  contra-indicated  if  the  countenance  is  pale,  the  head  cool, 
the  skin  generally  cold,  the  pulse  soft,  quick,  and  variable  as  to  force 
and  frequency,  the  patient  old,  his  habits  intemperate,  or  his  diet  sud- 
denly changed  from  a  stimulating  to  an  abstemious  one,  or  his  having 
been  exhausted  by  want  of  food  and  hurry  in  business. 

If  we  decide  to  use  the  lancet,  it  is  imperative  for  us  to  keep  our 
finger  on  the  pulse,  and  regulate  the  quantity  of  blood  taken  by  its  effects. 

"  The  peculiarities  of  the  pulse,"  says  Dr.  Burrowes,*  "  in  apoplexy 
and  other  cerebral  affections  must,  indeed,  be  noticed,  but  they  are  often 
very  perplexing,  especially  when  we  are  looking  to  the  state  of  the  cir- 
culation as  an  indication  for  treatment.  But  suppose  a  careful  exami- 
nation of  the  apoplectic  or  hemiplegic  patient's  heart  discloses  the  ex- 
istence of  valvular  disease  to  the  extent  of  obstructing  the  circulation 
through  its  cavities,  here  the  pulse  will  be  a  most  deceptive  guide  as 
to  the  propriety  or  impropriety  of  abstraction  of  blood.  If  the  mitral 
valve  be  principally  implicated,  and  allow  of  regurgitation  from  the  left 
ventricle,  the  small  and  irregular  pulse  so  commonly  observed  with  that 
lesion  would  probably  dissuade  from  that  free  abstraction  of  blood  which 
the  cerebral  symptoms  might  require.  If  in  another  case  of  apoplexy 
or  hemiplegia,  the  aortic  valves  be  found  diseased  to  the  extent  of  not 
only  obstructing  the  onward  current  of  blood,  but  also  of  allowing  regur- 
gitation into  the  ventricles,  during  its  diastole,  there  will  probably  be 
associated  with  this  lesion  considerable  hypertrophy  of  the  left  ventricle. 
There  will  be  observed  a  full  and  vibrating  or  thrilling  pulse,  but  a 
pulse  of  increased  action  without  real  power,  and  hence  a  deceptive 

*  Burrowes,  op.  cit,  p.  143-0. 


TREATMENT    OF    APOPLEXY.  399 

pulse;  and  one  which,  if  it  be  regarded  without  reference  to  the  struc- 
tural changes  of  the  heart,  would  invite  to  a  more  copious  abstraction 
of  blood  than  was  called  for  by  the  general  symptoms.  In  each  of  these 
last-mentioned  cases  greater  relief  to  the  symptoms  will  be  obtained  by 
a  free  local  abstraction  of  blood  from  the  vicinity  of  the  heart  (either  by 
cupping  from  beneath  the  left  mamma  or  between  the  left  scapula  and 
spine)  than  by  a  much  larger  depletion  by  venesection. 

"  Again,  there  are  other  instances  of  apoplexy  and  hemiplegia,  where, 
from  an  examination  of  the  heart  by  auscultation,  we  feel  assured  there 
is  serious  valvular  disease;  and,  from  the  character  of  the  cardiac  mur- 
murs, and  other  physical  signs,  we  arrive  at  a  well-grounded  suspicion 
that  there  is  osseous  deposit  about  the  valves  of  the  left  ventricle,  in 
the  coats  of  the  ascending  aorta,  and,  in  all  probability,  in  the  tunics  of 
the  arteries  within  the  cranium.  In  such  a  condition  of  the  arterial  sys- 
tem an  accidental  cerebral  congestion  may  have  been  followed  by  extra- 
vasation of  blood,  and  thus  have  arisen  the  most  common  symptoms 
of  apoplexy.  The  knowledge  obtained  through  auscultation  in  such 
cases  would  properly  dissuade  from  large  losses  of  blood,  although  the 
fullness  and  hardness  of  the  radial  pulse  might  at  first  have  invited  such 
depletion. 

"  There  are  other  cases  of  apoplexy  and  hemiplegia  where  we  dis- 
cover dilatation  of  the  cavities  of  the  heart  and  extensive  emphysema  of 
the  lungs;  the  latter  lesion  is,  indeed,  a  more  common  cause  of  cere- 
bral congestions  and  hemiplegia  among  the  laboring  classes  than  is  com- 
monly supposed.  In  such  cases  the  appearance  of  extreme  congestion 
and  dyspnoaa  might  tempt  to  practice  large  depletions,  and  thus  the  very 
symptoms  of  the  heart  which  have  induced  the  cerebral  congestion  and 
apoplectic  symptoms  would  be  aggravated.  I  should  here  suggest  the 
employment  of  cupping-glasses  to  the  nape  of  the  neck,  or  between  the 
scapulas,  with  the  internal  administration  of  stimulating  diuretics,  diffu- 
sible stimulants,  and  the  application  of  rubefacients  to  the  sternum. 
Many  mistakes  arising  from  the  causes  I  have  now  adverted  to  may  cer- 
tainly be  obviated  if  a  careful  examination  of  the  heart  and  lungs  be 
made  with  the  stethoscope  in  the  first  or  congestive  stage  of  apoplexy, 
or  immediately  after  an  attack  of  hemiplegia." 

Though  I  think 'at  the  present  time  there  is  some  danger  of  the  pro- 
fession falling  into  the  opposite  extreme  of  allowing  their  patients  to  die 
from  a  want  of  the  lancet,  it  must  be  allowed  that  we  are  much  indebted 
to  Dr.  Henry  Holland  and  some  others,  who  have  pointed  out  in  forcible 
language  the  mischief  which  accrues  from  indiscriminate  blood-letting. 

In  the  treatment  of  apoplexy,  especially  after  the  first  serious  symp- 
toms are  subdued,  it  is  often  much  more  important  to  do  nothing  than 
do  anything.  It  often  requires  great  moral  courage  on  the  part  of  the 
practitioner  to  combat  popular  prejudices,  and  it  is  often  absolutely 
necessary  to  prescribe  medicines  which  are  inert,  in  order  to  prevent 
mischief  being  done  by  others.  In  such  cases  we  can  do  no  harm,  and 
may  do  some  good,  by  prescribing  very  mild  diuretics. 

Dr.  Holland,  in  his  most  interesting  and  valuable  work,  entitled, 
"  Medical  Notes  and  Reflections,"  has  a  chapter,  headed  u  Bleeding  in 
Affections  of  the  Brain,"  which  he  thus  begins :  "  Is  not  depletion  by 


400  HUMAN    BRAIN. 

bleeding,  a  practice  still  too  general  and  indiscriminate  in  affections  of 
the  brain,  and  especially  in  the  different  forms  of  paralysis?  I  believe 
that  the  soundest  medical  experience  will  warrant  this  opinion."  He 
then  points  out  a  variety  of  cases  where  there  is  diminished  nervous 
power,  but  which,  from  their  resemblance  to  those  in  which  there  is  an 
excess  of  arterial  action,  there  is  danger  of  their  being  confounded,  as 
we  have  already  considered  under  the  head  of  anaemic  affections. 

The  following  observations  bear  so  directly  on  the  question  before  us, 
that  I  shall  not  hesitate  to  quote  them.*  "Even  where  the  tendency  to 
paralytic  seizure  is  generally  lessened  by  bleeding,  as  common  practice 
would  imply,  it  does  not  thence  follow  that  abstraction  of  blood  from 
the  brain  should  be  needful  or  desirable  in  immediate  sequel  to  such 
attack.  In  many  cases,  it  is  undoubtedly  otherwise.  The  paralysis, 
when  depending  on  apoplexy,  with  extravasation  of  blood  or  serum,  or 
on  other  cause  of  continued  pressure,  may  come  on  by  degrees,  and 
admit  of  relief  in  its  progress  by  emptying  the  vessels  of  the  head.  But 
often  it  occurs  as  an  instant  shock  to  a  portion  of  the  brain  or  spinal 
marrow,  without  any  proof  of  extravasation  or  obvious  cause  of  pressure ; 
the  shock  itself  being  of  momentary  duration,  though  it  leaves  lasting 
effects  on  parts  of  the  nervous  system  thereon  depending.  In  these 
cases  (and  they  are  frequent)  the  physical  causes  of  the  change  are  little 
known  to  us.  There  are  reasons  for  supposing  that  the  nervous  sub- 
stance itself  is  often  primarily  affected.  We  have  certainly  no  proof  of 
mere  pressure  from  fullness  of  vessels  being  concerned,  to  warrant  large 
bleeding,  especially  after  the  stroke  of  palsy  has  actually  occurred.  The 
degree  of  coma  attending  and  following  these  seizures  is  not  alone  suf- 
ficient cause  for  the  practice,  and  will  usually  subside  without  it,  where 
the  original  attack  is  not  such  as  to  endanger  life. 

"  Looking,  indeed,  to  the  magnitude  of  the  event  which  has  occurred 
between,  common  reason  would  suggest  a  doubt  whether  the  same  treat- 
ment can  be  desirable  immediately  before  and  after  a  stroke  of  palsy.  I 
do  not  mean  to  give  this  the  weight  of  an  argument.  From  the  nature 
of  the  circumstances,  it  is  extremely  difficult  to  bring  unequivocal  proofs 
on  the  subject;  but  there  is  much  cause  to  believe  that  the  practice  of 
bleeding  in  the  latter  case  is  often  injuriously  pursued.  The  risk,  I 
believe,  will  generally  be  less  from  waiting  a  certain  time,  to  observe 
the  effect  of  what  has  occurred  upon  the  circulation,  the  breathing,  and 
the  sensibility,  than  from  hastily  taking  away  blood  at  the  moment  of  a 
great  shock  to  the  brain,  and  before  we  can  rightly  appreciate  its  con- 
sequences. This  effect  upon  the  greater  functions  of  life,  gives  us,  in 
fact,  the  best  information  we  can  have  in  guidance  of  further  practice. 
But  this  we  forfeit  in  great  part  by  the  disturbance  any  large  depletion 
makes  in  the  system,  and  particularly  in  the  organs  upon  which  these 
functions  depend.  The  importance  of  this  consideration  may  be  readily- 
understood.  It  is  a  point  constantly  before  us  in  practice. 

"  Even  where  evidence  is  obtained  of  the  fitness  of  bleeding  soon 
after  one  paralytic  attack,  for  the  prevention  of  another,  the  question 
still  remains  as  to  the  manner  of  this;  whether,  by  copious  depletion  at 
once,  or  by  smaller  bleedings,  repeated  as  observation  may  suggest. 

*  Op.  cit.,  p.  45. 


TREATMENT   OF   APOPLEXY.  401 

And  this  question  the  practitioner,  while  prepared  for  boldness  in  all  fit 
and  urgent  cases,  is  bound  always  to  keep  before  him ;  seeing,  espe- 
cially, that  any  great  excess  in  the  remedy  may  hurry  on  the  very  mis- 
chief it  is  sought  to  prevent.  I  believe  that  in  most  cases  the  latter 
method  is  to  be  preferred.  It  accords  better  with  the  state  of  our  know- 
ledge of  these  disorders;  involves  no  irretrievable  step;  and  in  its  pro- 
gress affords  the  information  most  requisite  to  decide  how  far  it  should 
be  carried  into  effect.  Paralytic  cases  there  presumably  are  of  such  a 
nature,  that  a  few  ounces  of  blood  taken  away  at  regular  intervals  will 
ward  off  a  recurrence  of  the  attack,  which  any  large  or  sudden  deple- 
tion would  probably  hurry  on.  The  proof  here  can  seldom  be  explicit, 
but  the  presumption  is  one  I  have  often  been  led  to  entertain.  These 
remarks,  and  the  cautions  they  suggest,  are  familiar  to  many,  and  to  such 
needless.  But  I  feel  assured,  from  what  I  have  seen,  that  they  ought  to 
be  carried  further  into  general  practice.  The  use  of  the  lancet  is  easy, 
and  gives  a  show  of  activity  in  the  practitioner  at  moments  when  there 
appears  peculiar  need  of  this  promptitude.  Current  opinions  and  pre- 
judices are  wholly  on  the  side  of  bleeding;  and  the  complexity  and 
danger  of  the  cases  tend  to  obscure  the  results  of  the  treatment  pursued. 
The  physician  needs  all  his  firmness  to  decline  a  practice  thus  called 
for,  where  the  event  is  so  doubtful,  and  where  death  may  be  charged 
upon  his  presumed  feebleness  or  neglect." 

"  While  making  these  remarks,  however,  I  must  be  understood  as 
recognizing,  in  the  fullest  sense,  the  value  and  need  of  this  remedy, 
promptly  and  vigorously  used,  in  various  cerebral  diseases,  or  ^"pre- 
vention of  such,  where  well-marked  symptoms  lead  to  their  anticipation. 
And  I  dwell  upon  this  the  more  earnestly,  lest,  while  merely  inculcating 
a  cautious  discrimination  as  to  the  cases  for  its  use,  I  may  seem  to  be 
seeking  reasons  against  the  practice  altogether.  In  active  inflammation 
of  the  brain  or  its  membranes — in  many  states  of  pressure  from  conges- 
tion in  the  head,  topical  or  general,  without  inflammation — in  cases 
where  extravasation  may  be  presumed  to  be  going  on — and  even  in 
other  conditions  of  cerebral  irritation  less  definite  than  these,  we  have 
no  method  of  treatment  equally  effectual;  and  safety  often  depends 
solely  on  the  speed  and  sufficiency  of  its  employment.  But  almost  in 
the  same  ratio  with  the  necessity  of  the  remedy  in  the  above  cases  is 
the  importance  of  refraining  from  depletion  in  other  instances,  often  with 
difficulty  to  be  distinguished  from  the  former.  And  in  the  right  direc- 
tion of  diagnosis  and  treatment  here,  we  have  the  best  proof  that  the 
mind  of  a  practitioner  is  equal  to  the  most  difficult  exigencies  of  his 
profession." 

Mr.  Copeman  has  published  an  interesting  series  of  cases  to  illustrate 
the  dangers  of  bleeding  in  apoplexy,  which  are  worthy  of  perusal. 

After  the  practitioner  has  relieved  the  immediate  effects  of  the  apo- 
plectic seizure  by  blood-letting,  carried  as  far  as  the  circumstances  of 
the  case  admit,  he  has  still  much  to  do.  Mercury  must  be  his  sheet- 
anchor  in  every  case,  though  the  mode  of  administration  may  vary 
according  to  the  constitutional  powers  of  the  patient,  the  amount  of 
plethora,  and  the  state  of  the  bowels.  The  best  plan  is  to  raise  the 
cuticle  immediately,  either  by  means  of  the  liq.  ammon.  fort,  or  boiling 
26 


402  HUMAN    BRAIN. 

water,  and  dress  the  raw  surface  with  the  strong  mercurial  ointment. 
Calomel  should  be  given  internally  in  doses  of  two  grains  every  hour, 
or  five  grains  every  four  hours  if  the  patient  is  plethoric,  for  twelve  or 
twenty  hours,  watching  the  effect  closely.  If  there  is  much  debility  the 
hydrargyrus  c.  creta  in  two  or  five  grain  doses  is  better.  Emetics  have 
been  recommended,  but  they  are  dangerous. 

The  value  of  purgatives  in  the  treatment  of  apoplexy,  especially  the 
croton  oil,  is  acknowledged  by  every  experienced  practitioner.  With 
respect  to  mercury,  Dr.  Bright  gives  the  following  practical  hint :  "  We 
should  be  careful  not  to  administer  calomel  before  the  powers  of  deglu- 
tition are  sufficient  to  insure  its  being  swallowed.  I  once  saw  most 
serious  consequences  result  from  this ;  for  having  put  five  grains  of 
calomel  on  the  tongue,  and  attempted  to  wash  it  down  with  a  cathartic 
draught,  the  calomel,  instead  of  passing  into  the  stomach,  remained, 
moved  about  by  the  tongue,  and  produced,  in  a  few  hours,  a  most 
alarming  ptyalism,  in  which  the  tongue  was  forced  out  of  the  mouth,  and 
it  was  necessary  to  scarify  it  deeply  before  it  could  be  returned  within 
the  teeth." 

In  the  treatment  of  apoplexy,  after  the  first  effect  of  the  fit  is  subdued, 
the  practitioner  must  always  bear  in  mind  that  there  is  still  remaining  in 
or  on  the  brain,  extravasated  blood,  which  has  a  tendency,  like  an  ex- 
traneous body,  to  excite  inflammation.  After  a  day  or  two,  when  con- 
sciousness has  been  more  or  less  restored,  the  patient  may  be  observed 
raising  his  hand  to  his  head,  and  showing,  by  his  movements,  that  he  is 
suffering  in  that  direction.  The  head  will  be  found  unnaturally  hot,  and 
more  so  on  the  side  opposite  the  paralyzed  lirnbs,  in  a  case  of  hemi- 
plegia. 

It  is  in  this  stage  that  leeches  to  the  scalp  and  cold  applications  will 
be  found  especially  useful,  followed  by  blisters  to  the  nape  of  the  neck. 

Diuretics  may  be  employed  with  benefit,  and  the  inf.  digitalis  with 
the  bichlorid.  of  mercury  is  one  of  the  best :  the  inf.  armoracae  with 
spirit,  aeth.  nit.,  or  the  inf.  buchu,  with  tincture  of  squills,  are  also  very 
useful  and  less  active. 

In  the  convalescent  stage  of  apoplexy,  after  all  the  active  symptoms 
have  been  subdued,  but  a  certain  amount  of  paralysis  still  remains,  it  is 
often  a  very  difficult  question  as  to  what  tonics  may  be  employed  with 
advantage.  I  believe  that  of  the  mineral  tonics  there  are  only  two  at  all 
admissible  :  these  are  zinc  and  silver,  and  they  may  only  be  given  in 
very  small  doses. 

The  power  of  nux  vomica  in  stimulating  the  nervous  system  has  in- 
duced some  practitioners  to  employ  it,  but  I  am  convinced  it  is  a  very 
dangerous  remedy.  I  have  seen  it  do  much  harm,  and  whenever  there 
is  any  indication  of  either  existing  or  latent  inflammatory  action,  it  must 
not  be  thought  of.  Dr.  Bright  says,*  "  In  a  case  of  local  paralysis,  I 
have  applied  this  powerful  remedy  in  doses  of  the  ^th,  ^th,  and  ^  a 
grain  to  a  blistered  surface,  with  the  effect  of  producing  spasmodic 
action  through  the  paralyzed  muscle,  and  I  have  sometimes  adminis- 
tered it  internally  with  advantage.  But  cases  of  hemiplegia  from  rup- 


•  P.  338. 


TREATMENT    OF    APOPLEXY.  403 

ture  of  vessels  are  not  those  in  which  this  remedy  holds  out  the  greatest 
prospect  of  success,  though  with  caution  it  may  be  employed  in  the  ad- 
vanced stages  of  convalescence,  with  safety,  at  least,  and  sometimes 
with  benefit." 

Dr.  Burrows  does  not  recommend  strychnia  in  these  cases.  He  says  : 
"  My  opinion  as  to  the  effects  of  strychnia  as  a  direct  stimulus  to  the 
nerves  in  hemiplegia  is  even  less  favorable  than  that  which  I  have  ex- 
pressed respecting  electricity.  In  some  cases  strychnia  does  much  harm 
by  aggravating  the  wearing  pains  in  the  affected  limbs  to  a  much  more 
acute  suffering."  He  recommends  friction  as  very  beneficial. 

After  the  acute  symptoms  have  been  removed,  but  paralysis  remains, 
the  bichlorid.  of  mercury  will  be  found  useful :  thus,  Liq.  hyd.  bichlo- 
rid.  3i.,  Tinct.  lyttae,  ^Ix.,  Decoct,  sarsaparill.  3iv.  ter.  in  die. 

I  have  also  seen  decided  benefit  from  the  tincture  of  iodine,  as  a  lo- 
cal application  to  the  head.  This  was  very  evident  in  the  following 
case,  which  is  interesting  in  many  other  respects. 

Case  73. — On  the  9th  of  March,  1842,  I  was  consulted  by  a  Miss  P.,  of  Skinner  Street, 
Holborn,  for  paralysis.  When  I  first  saw  her  she  could  scarcely  articulate  a  word  which 
was  intelligible  to  me,  though  her  sister,  who  accompanied  her,  was  able  to  explain  what 
she  meant  to  say. 

The  right  arm  was  quite  paralyzed,  much  smaller  than  the  left,  the  fingers  contracted,  the 
nails  clenched  in  the  hand,  and  very  hard.  The  right  leg  not  wholly  useless,  but  she  has 
very  little  power  over  it,  and  walks  with  the  greatest  difficulty.  The  motion  of  a  carriage 
on  the  stones  affects  hef  head  so  much  that  she  is  obliged  to  walk  as  well  as  she  can.  I 
learn  that  she  had  lately  been  twice  electrified  at  Guy's  Hospital,  but  without  any  benefit, 
and  that  they  subsequently  refused  to  admit  her  as  an  in-patient,  stating  they  considered  her 
case  incurable. 

9th. — I  prescribed  for  her  hydr.  c.  creta  gr.  ij.  Ext.  Q.  S.  ut  fiat  Pil.  om.  nocte  sumend., 
and  the  tinct.  of  iodine,  to  be  painted  on  the  back  of  the  head,  where  she  complains  of  most 
pain. 

I  learnt  from  her  sister  that  she  was  first  attacked  on  the  18th  of  May,  1840;  that  is, 
one  year  and  nine  months  previous  to  my  first  seeing  her. 

Considers  that  she  has  always  had  a  tendency  to  the  rushing  of  blood  to  her  head,  feeling 
it  in  her  face  and  head  ;  had  suffered  more  or  less  for  years  with  headaches,  but  they  had 
been  much  worse  for  about  a  month  previous  to  this  seizure,  which  she  has  since  described 
to  me  as  coming  on  with  at  first  a  loss  of  power  in  the  arm  and  a  difficulty  of  speech,  but 
she  was  perfectly  sensible,  and  immediately  sent  one  of  the  family  for  the  doctor ;  but 
in  ten  minutes  from  the  occurrence  of  the  first  symptom  she  had  lost  all  power  of  speech. 

For  the  following  details  I  am  indebted  to  Mr.  Fisher,  of  King  Street,  Snow  Hill,  who 
attended  her  at  that  time. 

Miss  P.,  aged  40,  of  spare  habit,  but  previously  healthy,  sanguine  nervous  temperament, 
active,  industrious  habits.  On  the  18th  of  May,  1840,  had  ridden  to  Camberwell  and  back, 
arrived  at  home  in  the  evening,  and  suddenly  became  hemiplegic,  with  complete  loss  of 
speech,  intellect  otherwise  quite  unaffected,  pulse  strong,  full,  and  rather  frequent.  Vene- 
sectio  ad  deliquium,  Hab.  01.  Tiglii  gtt.  iij.  in  pil.  ij.  quarurn  st.  j.  statim  et  rep.  in  hor.  duobus. 

19th. — Symptoms  unaltered,  bowels  not  acted  on,  a  powerful  purgative  enema  adminis- 
tered, and  a  purgative  mixture  given.  Evening,  cupped,  and  blister  to  nape  of  neck. 

20th. — Bowels  acted  on  freely — no  alteration,  cannot  take  medicine. 

21st. — Strength  sinking  rapidly,  dark  thick  typhoid  fur  on  tongue,  and  other  signs  of  ex- 
treme collapse.  Small  doses  of  Amm.  Sesquicarb.  every  hour. 

24th. — A  little  food  at  length  taken,  but  no  medicine;  health  improving,  but  the  paralysis 
continues  unmitigated.  To  take  an  occasional  mild  aperient,  and  small  doses  of  Inf.  CahunbEe, 
with  tinct.  Aurantii  gj.  every  four  hours. 

June  7th. — Health  has  continued  to  improve  under  the  above  treatment,  but  only  very 
slight  improvement  in  the  nervous  symptoms;  some  motion  in  the  leg;  able  to  say  yes  and 
no;  but  although  she  evidently  uses  them  as  negative  and  affirmative,  she  uses  them  indis- 
criminately, very  expressively  nodding  her  assent,  and  saying  at  the  same  time,  "  no,  no," 
and  vice  versa,  as  often  as  using  them  correctly.  She  has  also  once  been  heard  to  pronounce 
the  word  Father.  She  has  been  requested  to  write,  but  cannot  accomplish  anything  having 


404  HUMAN   BRAIN. 

the  least  resemblance  to  a  letter,  although  she  could  before  write.  She  has  never,  from  the 
first,  had  the  least  difficulty  in  understanding  everything  said  to  her,  nor  in  making  herself 
understood,  so  far  as  can  be  accomplished  by  signs,  and  by  expression  of  countenance, 
which  is  not  so  much  impaired,  as  the  paralysis  is  not  so  complete  in  the  face  as  in  the 
limbs. 

17th. — Able,  with  difficulty,  to  sit  up  ;  motion  of  lower  limb  somewhat  improved;  more 
command  of  speech,  which  is  extremely  imperfect.  But  the  following  facts  have  been  with 
difficulty  elicited.  She  had  lost  entirely  the  power  of  remembering  all  words,  and  of  course 
the  names  of  all  letters ;  therefore,  she  could  not  read,  although  she  perfectly  recollected  the 
purport  of  every  word  addressed  to  her  viva  voce.  About  this  time  I  put  her  to  the  test  by 
writing  the  word  shell  with  another  word,  and  showing  her  a  shell,  asked  which  word  was 
the  name  of  the  object  shown;  after  an  effort  she  selected  the  wrong  word,  although  it  had 
no  resemblance  to  the  right  one.  •:  In  addition  to  the  former  treatment  a  stimulating  lini- 
ment was  now  prescribed. 

20th. — Seen  to-day  by  Dr.  Farre,  who  ordered  her  to  take  every  four  hours  Tinct.  Aurantii 
gfs.  Spt.  Amm.  Arom.  TT^iv.  in  Inf.  Valerian*  ^j.  and  to  continue  the  liniment. 

July  1st. — Removed  to  Camberwell,  and  was  advised  to  continue  the  medicines  with  an 
occasional  Aloetic  aperient.-  The  catamenia  were  during  the  whole  time  regular.  The 
sphincters  also  performed  their  office  efficiently. 

20th. — Mouth  becoming  tender;  first  moved  her  arm  slightly  to  day. 
23d. — Can  raise  her  arm  to  touch  her  forehead;  feeling  has  partially  returned;  bowels 
confined.     Pil.  Rhei.  co.  gr.  v.  o.  n.  alvus  constricta  sit. 

29. — Has  gained  more  power  in  her  arm  and  leg.     Speech  improving. 
April  1st. — Not  quite  so  well;  appetite  failing  a  little;  to  go  on  with  the  gray  powder,  in 
the  dose  of  one  grain,  and  take  Inf.  Aurant.  co.  ^j.  Tinct.  Calumb.  3J.     Soda?  Carbon,  gr.  x. 
tres  die. 

6th. — Better  again;  more  power  of  moving  her  leg;  can  now  feel  a  little  in  her  leg  and 
toe  the  sensation  of  pins  and  needles ;  speech  improved. 

8th. — Complains  of  continual  aching  pains  in  the  leg;  speaks  much  better;  can  nearly 
say  anything  she  wants,  and  the  names  of  things  which  she  could  not  before  remember 
during  her  illnes  she  now  remembers,  and  can  say  them ;  can  raise  the  arm  higher;  finger 
nails  softer;  mouth  very  sore:  to  take  only  one  grain  of  the  gray  powder  at  night,  and  use 
the  chlorate  of  soda  gargle. 

13th. — Can  raise  the  arm  to  the  head;  speech  much  the  same  ;  pains  in  the  limbs  less; 
sensation  so  much  returned  in  the  leg  that  she  can  now  feel  with  it,  whether  it  is  hot  or  cold, 
which  she  has  not  been  able  to  do  before.  Can  read  the  newspaper  to  herself,  and  under- 
stand it,  which  she  has  not  been  able  to  do  since  her  first  attack. 

25th. — Mouth  and  throat  exceedingly  sore;  to  discontinue  all  medicine,  and  use  the  gargle, 
and  take  Olii  Ricini  ^j. 

29th. — Better;  occasional  shooting  pains  in  the  limbs,  and  a  sensation  of  scalding  on  that 
side  generally,  both  in  the  limbs  and  face. 

May  5th. — Improving;  can  now  turn  in  bed,  which  she  has  not  before  been  able  to  do; 
taking  the  Iodine  and  Gent.  t.  d. 

22d. — When  sitting  up  in  bed  reading,  she  felt  a  curious  sensation  down  the  affected  side, 
and  almost  immediately  afterwards  lost  all  consciousness.  She  was  found  by  her  sister  on 
the  floor  perfectly  insensible,  very  pale  and  cold.  A  Mr.  Cooke,  the  nearest  medical  man, 
was  sent  for,  who  sent  her  a  draught,  and  said  that  nothing  else  could  be  done  for  her.  She 
recovered  her  senses  gradually. 

23d. — I  visited  her  this  day,  and  found  her  much  the  same  as  usual,  only  that  her  speech 
was  not  quite  so  clear,  and  her  power  of  walking  less  than  before  the  attack.     Her  pulse 
was  quick  and  exceedingly  feeble ;  she  said  she  had  a  little  headache,  but  not  much. 
I  ordered,  Quin.  gr.  i.  Pil.  Aloes  co.  gr.  ij.  bis.  in  die. 

24th. — The  report  of  her  sister  is,  that  she  is  rather  better,  and  does  not  complain  of 
headache. 

25th. — Very  weak;  no  headache;  bowels  confined.     Quin.  gr.  ij.  Pil.  Rhei.  co.  gr.  ij.  t.  d. 

July  22d. — She  has  remained  out  of  town  until  a  few  days  ago,  and  without  any  material 

change  taking  place.     When  I  saw  her  to-day,  I  foynd  her  looking  much  the  same  as  usual. 

the  speech  very  imperfect.     She  complained  of  pain  in  her  head,  and  I  ordered  her  two 

leeches  and  a  purge. 

25th. — She  did  not  apply  the  leeches  when  ordered,  but  the  following  day  she  suffered  so 
much  from  her  head,  and  felt  as  if  she  was  going  to  have  a  fit,  that  she  applied  them,  and 
found  much  relief. 

Sept.  12. — Has  not  been  taking  any  medicine  for  fourteen  days,  but  she  has  continued  the 
Iodine  to  the  head  ;  she  is  much  better,  both  as  regards  her  speech,  and  she  can  walk  better, 
and  feels  her  arm  and  foot  much  better,  and  is  stronger  in  her  general  health. 


CONVULSIVE    AFFECTIONS.  405 

26th. — Has  continued  to  apply  the  tincture  of  Iodine  to  the  head,  and  is  improving :  has 
more  feeling  in  her  side,  and  her  speech  is  improving,  and  she  is  gaining  strength. 

Oct.  7th. — Considers  that  she  is  not  so  strong  as  she  was. 

Ordered  her,  Mist.  Iodine  ex  Gent. 

29th. — Had  a  fit  this  morning,  which  was  considered  by  Mr.  Fisher,  who  saw  her  at  the 
time,  to  be  a  fainting  fit;  the  sister  says  that  she  does  not  perceive  anymore  paralysis  in  the 
arm  or  leg ;  a  little  more  difficulty  of  speech  ;  she  got  up  with  a  headache,  and  felt  sick ;  it 
occurred  at  eight  o'clock ;  she  has  been  suffering  from  headache. 

Ordered — Cal.  gr.  ij.  Pil.  Rhei.  co.  gr.  viij.  h.  n.  haust.  p.  eras  mane. 

31st. — Better  5  but  still  feels  a  weight  in  the  back  of  her  head. 

Ordered — Hirud.  j.  regioni  cerebelli. 

Nov.  4th. — Relieved  by  the  leech  from  pain  ever  since.  Her  sister  reports  to  me  to-day 
that  she  is  exceedingly  weak,  and  that  she  is  so  excessively  sleepy  that  she  falls  asleep  as 
soon  as  she  sits  down  in  her  chair,  however  great  the  noise.  This  symptom  has  only 
existed  for  the  last  two  or  three  days.  Bowels  opened  with  the  Conf.  Sen. :  appetite  very 
good. 

1 843,  January  2d. — Has  been  stopping  at  Hampstead,and  is  much  better  in  every  respect. 

July  14th. — I  lost  sight  of  this  patient  since  the  last  date,  but  I  now  learn  that  she  is 
much  better,  can  walk  three  or  four  miles,  and  her  speech  is  better  5  she  does  not  take  any 
medicine,  but  continues  the  Tinct.  lod.  to  the  head,  and  she  finds  if  she  leaves  it  off  her 
speech  becomes  worse. 

Convulsive  Affections. — Convulsions,  from  convellere,  "  to  tear  or  pluck 
up."  The  terra  is  now  confirmed  pathologically  to  sudden,  spasmodic, 
involuntary  action  of  muscles.  Convulsions  are  most  frequently  the 
effect  of  disease,  either  functional  or  organic,  of  the  cerebro-spinal  axis, 
sometimes  the  effect  of  injury.  I  do  not  purpose,  in  this  place,  to  attempt 
an  account  of  convulsive  diseases  generally,  but  only  those  which  appear 
dependent  on  derangement  of  the  circulation  of  blood  in  the  brain,  or 
lesion  of  its  substance. 

Let  us  first  direct  our  attention  to  those  convulsions  which  appear  the 
result  of  direct  violence  done  to  the  brain.  In  doing  this,  it  will  be 
found  instructive  to  combine  physiological  inferences  with  those  patho- 
logical deductions  which  are  to  direct  the  diagnosis  and  guide  the  treat- 
ment. 

In  considering  the  pathology  of  convulsions,  I  think  it  will  be  found 
that  the  same  law  holds  good  as  in  inflammatory  affections.  In  inflam- 
matory affections,  we  have  already  observed  that  mental  excitement  is 
an  indication  of  inflammation  or  irritation  of  the  hemispherical  ganglion, 
and,  I  believe,  it  will  be  found  that  convulsions  are  indications  of  irri- 
tation or  inflammation  of  the  tubular  neurine,  either  where  it  is  in  con- 
tact with  the  vesicular  neurine,  or  in  its  course  to  the  muscles,  or  of  the 
vesicular  neurine,  from  whence  the  power,  which  excites  the  muscles, 
emanates;  thus  confirming  the  truth  of  the  law  we  have  already  investi- 
gated, that  irritation  of  the  cerebral  substance,  either  by  inflammation  or 
mechanical  means,  first  excites  its  normal  action,  though  it  may  lead  to 
its  ultimate  destruction. 

I  have  quoted  a  case  from  OHiviep,*  of  "spontaneous  hemorrhage  and 
rupture  of  the  cephalic  bulb  of  the  spinal  marrow  and  of  the  annular 
protuberance,  accompanied  with  convulsive  contractions  of  the  limbs." 
This  author  says,  "  I  have  since  had  several  opportunities  of  observing 
this  apoplexy  at  the  moment  of  the  attack,  and  I  have  always  remarked 
convulsive  contractions  in  the  upper  extremities,  with  alternating  move- 
ments of  rotation  inwards.  The  opening  of  the  mouth  underwent  no 

*  P.  500. 


406  HUMAN    BRAIN. 

change.  The  spasmodic  convulsions  observed  at  the  commencement  of 
the  attacks  of  apoplexy  in  general,  seem  to  me  to  depend  on  the  irrita- 
tion which  the  blood  produces  on  the  extremities  of  the  torn  medullary 
fibres,  with  which  it  remains  in  contact,  and  on  which  it  must  act  as  an 
irritant. 

The  following  case,  from  Mayo's  Outlines  of  Pathology,*  seems  to 
be  highly  instructive,  though  the  narrator  does  not  appear  to  have  duly 
appreciated  its  important  bearing  on  the  physiology  of  convulsions. 

Case  74. — W.  Tucker,  setat.  42,  brought  into  the  Middlesex  Hospital,  and  supposed  to  be 
intoxicated.  He  was  drowsy,  heavy,  stupid,  not  insensible;  answered  some  questions;  the 
pulse  small  and  slow.  The  left  arm  and  leg  powerless;  face  drawn  to  right  side.  When 
put  to  bed,  he  was  seized  with  rigor,  and  complained  of  pain  in  the  right  side  of  occiput ; 
in  an  hour  afterwards  the  pulse  rose,  and  the  right  side  of  the  body  became  convulsed :  v.  s. 
Sjxviij.:  the  convulsions  ceased  for  a  time,  then  returned  with  extreme  violence,  threatening 
to  suffocate  him:  v.  s.  ^xl.:  the  respiration  became  more  free, but  the  convulsions  remained: 
he  then  became  comatose.  He  continued  insensible  during  the  night,  the  breathing  stertorous, 
right  pupil  dilated,  left  contracted,  no  pulse  at  the  wrist:  he  died  at  11  A.  M.  A  large  cavity 
filled  with  blood,  partly  clotted,  occupied  the  centre  of  the  right  hemisphere  of  the  brain : 
it  did  not  communicate  with  the  lateral  ventricle,  but  opened  between  the  sulci  of  the  con- 
volutions, which  for  a  large  extent  were  lined  with  it;  between  their  summits  streaks  of 
clotted  blood  lay.  resembling  veins.  There  was  slight  sanguineous  effusion  on  the  surface 
of  the  anterior  lobe  of  the  left  hemisphere.  It  is  possible,  but  very  unlikely,  that  this  may 
have  caused  the  convulsions  of  the  right  side  of  the  body. 

I  confess  I  am  surprised  at  Mr.  Mayo's  concluding  observations, 
when  cases  like  the  following,  related  by  Abercrombie,  are  to  be  met 
with  so  frequently.! 

Case  75. — A  man  aged  about  35,  keeper  of  a  tavern,  and  addicted  to  the  constant  use  of 
ardent  spirits,  had  been  drinking  to  intoxication  during  the  night  betwixt  the  12th  and  13th 
of  July  1816;  and,  about  seven  o'clock  in  the  morning,  was  found  lying  in  a  state  of  violent 
convulsion.  No  account  could  be  obtained  of  his  previous  state,  except  that  during  the 
evening  he  had  drunk  a  very  large  quantity  of  whisky,  and  that  when  he  was  last  seen, 
about  three  o'clock  in  the  morning,  he  was  walking  about  his  house,  but  unable  to  speak. 
He  was  seen  by  Dr.  Hunter  at  a  quarter  before  eight.  He  was  then  lying  on  his  left  side, 
in  a  state  of  perfect  insensibility,  with  laborious  breathing;  saliva  was  flowing  from  his 
mouth  ;  his  eyes  were  much  diffused  and  greatly  distorted,  the  cornea  of  both  being  com- 
pletely concealed  below  the  upper  eyelid;  pulse  120,  full  and  soft.  While  Dr.  Hunter  stood 
by  him  he  was  again  seized  with  convulsion  ;  it  began  in  the  muscles  of  the  jaw,  which 
was  drawn  from  side  to  side  with  great  violence,  producing  a  loud  jarring  sound  from  the 
grinding  of  the  teeth.  The  spasms  then  extended  to  the  body  and  extremities,  which  were 
first  thrown  into  a  state  of  violent  extension  and  then  convulsed  for  one  or  two  minutes; 
they  then  subsided,  and  left  him  as  before  in  a  state  of  perfect  insensibility.  Similar  attacks 
took  place  four  times  while  Dr.  Hunter  was  in  the  house,  which  was  about  half  an  hour  ; 
and  he  expired  in  another  attack  of  the  same  kind  about  two  minutes  after.  Blood-letting 
and  every  other  remedy  that  the  time  admitted  of  were  employed  in  the  most  judicious 
manner. 

Inspection — On  removing  the  skull-cap  an  appearance  was  observed  on  the  surface  of  the 
dura  mater  of  coagulated  blood  in  small  detached  portions.  These  appeared  to  have  been 
discharged  from  small  glandular-looking  elevations  on  the  outer  surface  of  the  dura  mater, 
which  were  very  vascular  and  highly  gorged  with  blood.  There  were  depressions  on  the 
inner  surface  of  the  bone  which  corresponded  with  these  bodies.  On  raising  the  dura  mater 
there  came  into  view  a  coagulum  of  blood,  covering  and  completely  concealing  the  ri^ht 
hemisphere  of  the  brain;  it  was  about  two  lines  in  thickness  over  the  middle  lobe  and  be- 
came gradually  thinner  as  it  spread  over  the  anterior  and  posterior  lobes,  and  dipped  down 
below  the  base  of  the  brain.  The  coagulum  being  removed  weighed  about  3-v.  On  the 
surface  of  the  left  hemisphere  the  veins  were  turgid  with  blood,  on  the  surface  of  the  right 
they  were  entirely  empty ;  but  the  source  of  the  haemorrhage  could  not  be  discovered. 
There  was  no  fluid  in  the  ventricles,  and  no  other  disease  was  discovered.  The  stomach 
being  carefully  examined,  was  found  to  contain  nothing  but  air  and  healthy  mucus. 

*  Part  I.  p.  208.  t  Abercrombie,  c.  x.  p.  243. 


CONVULSIVE    AFFECTIONS.  407 

Lallemand's  observations  on  the  opinions  which  used  to  prevail  on 
the  subject  of  convulsions  on  one  side  of  the  body,  and  paralysis  on  the 
opposite,  in  connection  with  wounds  of  the  head,  are  so  extremely  ap- 
posite that  I  cannot  resist  quoting  them.* 

"  You  have  just  heard  many  different  opinions  founded  on  observa- 
tions more  or  less  incomplete  concerning  injuries  of  the  head:  thus  some 
have  admitted  that  inflammation  of  the  brain  produced  convulsions  on 
the  opposite  side,  others  that  it  produced  paralysis,  and  others  that  it 
sometimes  occasioned  convulsions  and  sometimes  paralysis;  so  that  the 
convulsions  (always  of  the  opposite  side)  were  produced  by  inflamma- 
tion, and  paralysis  by  suppuration  ;  that  is  to  say,  by  compression  of  the 
brain.  Another  series  of  observations  brings  forth  other  opinions. 

"Salmuthiusf  found  in  a  patient  who  had  had  paralysis  on  one  side 
and  convulsions  on  the  other,  an  abscess  in  the  hemisphere  opposite  to 
the  paralyzed  side. 

"  Daniel  Hoffman  (Dissert,  de  Sanatione  rariss.)  relates  the  case  of  a 
child  who,  having  had  a  fracture  of  the  skull  on  the  left  side,  with  con- 
siderable destruction  of  the  brain,  had  paralysis  on  the  right  and  con- 
vulsive motions  on  the  left  side.  These  facts,  after  all,  are  very 
common ;  there  are  few  practitioners  who  have  not  observed  them. 

"BerengerJ  says  that  he  has  most  frequently  seen  convulsions  on  the 
sound  side  and  paralysis  on  the  opposite. 

"  'It  is  to  be  observed,'  says  Dr.  Hennequin,  *  that  when  on  one  side 
of  the  body  there  are  convulsions  and  on  the  other  paralysis,  the  con- 
vulsions attack  the  side  corresponding  to  the  injured  brain;  but  when 
convulsions  alone  are  present,  and  on  one  side  only,  it  is  generally  op- 
posite to  the  injury.' 

u  You  will  find  these  facts  described  by  various  authors,  very  nearly 
in  the  same  manner,  among  the  most  recent  of  which  I  will  cite  one  to 
which  the  author's  name  attaches  an  imposing  authority.  This  is  what 
Boyer  says:§ 

"  '  Paralysis  is  not  the  only  disorder  produced  by  compression  of  the 
brain  arid  alteration  of  its  substance.  Convulsions  are  also  sometimes 
caused  by  these  affections.  The  greater  number  of  observers  who  have 
remarked  that  paralysis  always  attacked  the  side  opposite  to  that  which 
was  injured,  have  at  the  same  time  observed  that  when  in  this  case 
convulsions  occurred,  they  attacked  the  side  opposite  to  that  paralyzed, 
that  is  to  say,  the  injured  side,  whilst  the  convulsive  motions  affected 
the  side  of  the  body  opposed  to  the  injury,  when  no  paralysis  existed.' 

"Amongst  the  authors  who  have  spoken  of  these  facts,  some  have 
contented  themselves  by  relating  them,  without  endeavoring  to  explain 
them ;  others  have  thought  that  the  same  affection  could  at  the  same 
time  produce  convulsions  on  the  injured  side,  and  paralysis  on  the  op- 
posite. Boyer  seems  to  be  of  this  number,  when  he  says  *  paralysis  is 
not  the  only  disorder,  &c.'  And  others,  persuaded  that  the  convulsions 
were  produced  by  inflammation,  and  the  paralysis  by  the  mechanical 

•  Op.  cit.,  p.  500. 

t  Obs.  Medtoor.  Centyriae  tres,  4to,  Bruns.  1648. 
j  Tract,  de  Fractura  Cranii,  4to,  Venet,  1535. 
§  Traite  des  Mai.  Chirurg.,  &c.,  torn.  v.  p.  109. 


408  HUMAN    BRAIN. 

compression  of  the  brain,  have  thought  that  in  this  case  the  hemisphere 
corresponding  to  the  injury  was  at  the  same  time  inflamed,  and  com- 
pressed by  blood,  serum,  or  pus.  But  thus  to  explain  these  two  orders 
of  symptoms,  required  that  the  opinions  of  the  ancients,  generally  re- 
ceived, should  be  rejected ;  and  this  is  what  is  done.  It  is  pretended 
that  the  symptoms  of  convulsions  are  quite  different  from  those  of  para- 
lysis; that  the  one  manifested  themselves  on  the  injured  and  the  other 
on  the  opposite  side.  So,  inflammation  and  compression  of  the  same 
hemisphere  of  the  brain  would  show  symptoms  in  the  first  case  on  the 
same  side  of  the  body,  and  in  the  other  on  the  opposite.  Although  the 
mere  relation  of  this  suffices  to  show  its  absurdity,  the  notion  has  had 
a  great  many  supporters. 

"  It  appears  that  in  Morgagni's  time  it  was  much  accredited,  for  he 
speaks  of  it  at  great  length,  and  combats  it  in  many  parts  of  his  works.* 
After  having  called  to  mind  the  decussation  of  the  fibres  of  the  brain, 
admitted  to  explain  the  cause  of  paralysis  on  the  opposite  side,  he 
finishes  with  this  judicious  reflection,  which  naturally  presents  itself  to 
the  mind:  'Igitur  quam  decussationem  ad  paralysim  in  latere  opposito 
explicandam  agnoscere  debeamus  quare  ad  convulsionem  non  agnos- 
cemus.' 

"Morgagni's  argument,  very  plausible  at  that  period,  fell  the  moment 
that  we  were  able  to  demonstrate,  by  the  scalpel,  the  interlacing  of  the 
fibres  of  the  brain,  which  was  then  but  a  hypothesis  more  or  less  pro- 
bable. That  even  has  not  hindered  this  opinion  from  being  propagated 
to  us,  and  I  have  heard  distinguished  practitioners  defend  it  warmly. 
Others,  always  after  the  same  observations  of  injuries  of  the  head,  have 
admitted  that  convulsions  could  occur  on  the  side  of  the  inflamed 
hemisphere,  or  on  the  opposite  side,  whether  this  last  was  free  or  para- 
lyzed— a  circumstance  much  more  difficult  to  be  conceived. 

"  It  has,  indeed,  been  imagined  that  convulsions  only  occurred  on 
one  side,  because  the  antagonist  muscles  were  paralyzed,  so  that  the 
healthy  ones  drew  the  others  to  their  own  side  ;  for  example,  pulled  the 
mouth  towards  one  or  the  other  ear,  bent  the  body  laterally,  &c.  But, 
without  considering  whether  this  action  of  the  healthy  muscles  can  be 
assimilated  to  the  permanent  contractions  or  tonic  convulsions  produced 
by  inflammation  of  the  brain,  it  is  evident  that  paralysis  of  the  muscles 
of  the  arm  or  leg  of  one  side  can  have  no  influence  over  the  limbs  of 
the  opposite  side.  Of  all  these  explanations,  the  most  reasonable,  the 
nearest  to  truth,  is  that  which  was  adopted  by  Mus,  Donatus,  Cesalpinus, 
P.  Martian,  Morgagni,  &c.  ;  they  thought  that  in  these  injuries  of  the 
head  the  cause  of  the  two  orders  of  symptoms  had  equally  its  seat  in 
the  cerebral  hemisphere  which  was  opposite  to  the  side  of  the  body 
affected  with  paralysis  or  convulsions ;  but  that  this  cause  was  of  a  dif- 
ferent nature,  that  is  to  say,  that  it  was  a  compression  or  a  mechanical 
lesion  of  the  one  hemisphere  which  produced  paralysis  on  the  opposite 
side,  and  an  inflammation  of  the  other  which  produced  convulsions  on 
the  other  side.  They  were  in  that  consequent  with  themselves,  and  they 

*  See  Epist.  Anat.,  xiii.,  Nos.  14,  17,  18,  &  22.  De  Sed.  et  Caus.  Morb.  Epist.,  Nos.  40, 
47,  &  48. 


CONVULSIVE   AFFECTIONS.  409 

explained  in  a  very  simple  manner  contradictory  facts  ;  yet  this  opinion 
did  not  prevail  generally,  and  for  this  reason  : 

"  In  many  cases  they  indeed  found  on  the  injured  side  an  effusion  of 
blood,  pus,  or  serum,  on  the  surface  of  the  arachnoid,  or  an  abscess  in 
the  brain,  alterations  which  explained  the  paralysis  of  the  opposite  side  : 
but  they  sometimes  only  found  the  dura  mater  and  arachnoid  injected, 
with  softening  of  the  subjacent  brain  :  nothing  then  proved  that  there 
had  been  compression  of  the  brain.  There  existed  the  great  difficulty: 
they  did  not  find  in  the  hemisphere  of  the  side  opposite  to  that  convulsed, 
evident  traces  of  inflammation  of  the  brain,  and  the  state  of  the  arach- 
noid was  thought  of  no  importance,  for  two  reasons  :  the  first,  as  you 
have  seen,  is,  that  it  is  much  more  inflamed  on  the  injured  side  than  on 
the  other  ;  so  that  by  comparison  they  thought  it  healthy  when  red,  in- 
jected and  opaque,  &c.  ;  the  second  is,  that  they  did  not  think  that  in- 
flammation of  the  arachnoid  was  more  likely  to  produce  convulsions  than 
delirium. 

"  Some  facts,  certainly  rather  rare,  threw  into  confusion  the  opinions 
of  authors  concerning  convulsions  and  paralysis  after  injuries  of  the  head. 
Paralysis  was  observed  to  take  place  on  the  side  injured,  and  convul- 
sions on  the  side  opposite  to  it ;  and  even  Avicenna,  who  probably  had 
seen  many  similar  cases,  thought  (De  Fract.  Cran.)  that  these  were  more 
common  'than  the  reverse.  They  were  for  a  long  time  very  much  em- 
barrassed how  to  explain  this  singular  phenomenon,  which  overthrew 
the  received  ideas  ;  but  when  they  opened  the  skulls  of  individuals  who 
had  died,  they  in  a  short  time  perceived  that  the  lesion  of  the  brain  was 
opposite  to  that  of  the  skull,  and  consequently  opposite  to  the  paralysis.* 

u  These  two  series  of  symptoms,  then,  explain  themselves  in  the  same 
manner  as  in  the  preceding  case.  I  have  seen  no  other  means  of  ex- 
hibiting to  you  in  the  most  simple  and  clear  manner  possible,  this  rapid 
sketch  of  all  these  opinions,  and  of  the  facts  upon  which  they  are  founded, 
than  by  reducing  them  to  their  most  simple  expression,  by  depriving 
them  of  that  vain  parade  of  erudition,  which  is  very  easily  abused,  and 
amid  which  it  is  so  difficult  to  see  one's  way. 

"  Yet  with  this  precaution  you  will  perhaps  find  that  the  labor  which 
such  an  extent  of  reading  requires  is  not  compensated  by  the  benefit 
reaped  from  it ;  but  I  have  thought  that  if  others  began  to  demolish 
before  they  build,  or  simply  to  pull  down  without  leaving  anything  in 
the  place  of  that  which  they  destroy,  I  could,  and  I  even  ought,  after 
endeavoring  to  build  upon  bases  more  extended  and  more  solid  than 
have  up  to  this  time  been  assumed,  to  try  to  make  everything  disappear 
that  might  oppose  your  progress.' 

"After  all,  you  see  that  the  cause  of  the  errors  which  have  reigned 
concerning  symptoms  of  inflammation  of  the  brain  is,  that  they  have  been 
studied  in  surgical  observations;  that  great  importance  has  always  been 

*  Amongst  others,  see  the  case  of  Paillot,  continued  by  M.  Ant.  Petit,  in  his  collection  of 
Clinic.  Observ.,  p.  223.  He  received  over  the  left  coronal  suture  a  sword  cut;  the  eighteenth 
day  the  left  arm  was  paralyzed,  the  paralysis  increasing  by  degrees,  and  he  died  the  26th 
day.  Under  the  wound  the  dura  mater  and  brain  were  healthy ;  on  the  anterior  lobe  of  the 
opposite  hemisphere  was  a  vast  abscess  which  had  penetrated  many  lines  in  its  substance. 
See  also  Morgagni,  Epist.  LI.,  No.  42  :  and  the  Observ.  of  M.  Dan  de  la  Vauterie,  Letter  I. 
No.  19. 


410  I  HUMAN    BRAIN. 

attached  to  the  external  wound,  and  little  attention  paid  to  the  symp- 
toms ;  and  this  in  considering  pathological  observations,  which  are  so 
much  more  complicated  than  cases  of  spontaneous  inflammation. 

"  You  also  see  that  all  these  opinions  were  founded  upon  facts  which 
have  been  reproduced  in  our  own  days,  because  nature  does  not  change  ; 
although  so  very  contradictory,  it  is  easy  to  explain  them,  and  even  to 
reconcile  them  one  with  another." 

Injuries  of  the  head  often  give  rise  to  convulsions.  This  fact  is  im- 
portant, both  in  a  surgical  and  physiological  point  of  view.  The  ap- 
pearance of  convulsions  after  injury  of  the  head  is  a  most  serious  symp- 
tom. If  it  occurs  within  a  few  hours  after  the  accident,  it  is  generally 
indicative  of  laceration  of  the  brain  ;  if  it  does  not  supervene  for  some 
days,  it  is  then  dependent  on  subsequent  inflammation. 

The  next  case  illustrates  the  fact  that  the  convulsive  fits  sometimes 
occur  after  a  blow  on  the  head  without  fracture,  and  that  the  injury 
which  gives  rise  to  them  is  riot  always  irremediable. 

I  have  no  doubt  that  the  convulsive  twitchings  in  this  case  were  occa- 
sioned by  some  injury  to  the  brain  produced  by  the  contre-coup,  and  the 
case  is  instructive  from  its  showing  how  gradually  serious  symptoms  will 
sometimes  arise  some  days  after  the  receipt  of  injury.  The  result  of  the 
local  depletion  and  counter-irritation  bear  out  this  view  of  it,  and  the 
general  tonic  plan  which  was  indicated  by  the  previous  habits  of  the 
man,  and  his  state  of  constitution,  is  important  to  attend  to,  from  the 
success  which  followed  its  adoption. 

Case  76. — Injury  to  the  head — William  Pearson,  set.  about  40,  a  pot-boy  at  a  public-house, 
was  admitted  into  George's  Ward  under  my  care,  May  16th,  1842,  with  a  small  lacerated, 
wound  on  the  left  side  of  the  head;  he  was  intoxicated  at  the  time  of  admission.  The  ac- 
cident was  caused  by  his  being  knocked  down  or  run  over  by  a  cart,  I  could  not  learn 
which. 

The  case  was  regarded  by  the  dresser  as  one  of  intoxication,  and  I  did.  not  see  him  until 
the  following  morning. 

17th. — He  now  complains  much  of  pain  in  his  head;  but,  with  this  exception,  there  were 
no^symptoms  indicative  of  cerebral  mischief,  and  the  headache  I  considered  more  character- 
istic of  disordered  stomach  than  brain.  There  was  no  drowsiness,  and  his  manner  was  na- 
tural ;  he  referred  the  pain  to  his  forehead,  and  not  to  the  seat  of  injury ;  his  pupils  acted 
naturally. 

I  ordered — Pulv.  Jalapse  c.  Cal.  £J.  stat.  M.  S.  C.  6ta.  hor.  post. 

In  the  evening,  finding  that,  though  his  bowels  had  been  relieved,  the  pain  in  the  head 
continued,  I  ordered  him  Calomel,  gr.  v.  4ta.  hora. 

18th. — Symptoms  much  the  same. 

Ordered — Opium,  gr.  j.  at  night,  and  repeat  the  Cal.  and  Jalap,  as  a  purge. 

19th. — Has  had  convulsive  movements  of  the  left  side  of  the  face,  of  an  epileptic  charac- 
ter. Tongue  drawn  to  the  left  side.  Constantly  spitting  a  large  quantity  of  frothy  saliva. 
Both  pupils  are  alike,  and  slightly  contracted,  but  act  freely  to  the  light.  Pulse  116,  weak. 
He  is  quite  conscious,  and  answers  all  questions  naturally,  though  he  has  not  perfect  power 
of  speech.  I  again  examined  the  head,  and,  for  the  first  time,  perceived  that  there  was 
some  tenderness  on  pressure  on  the  right  of  the  head,  opposite  the  wound. 

Ordered — Hirudines  xx.  to  the  right  side  of  the  head;  to  be  followed  by  a  blister. 

Opii  Tinctura,  TT^xxx. ;  Spirit.  Ammon.  Arom.  gfs. ;  Mist.  Camphor.  ^  j.  hac  nocte. 

20th. — Says  he  found  relief  from  the  leeches,  and  his  head  is  much  better,  though  still 
very  .bad.  Pulse  soft. 

22d. — No  appearance  of  twitching,  but  tongue  still  drawn  to  the  left  side.  Has  vomited 
some  greenish  bile.  Pulse  soft. 

Ordered — Hirudines  xxx.  to  the  right  side.     Port  wine  ^vj.  in  arrowroot. 

23d. — Says  his  head  is  much  better,  though  not  quite  free  from  pain.  Has  only  had  one 
fit  of  convulsive  twitching  since  the  last  report  Pulse  still  weak. 

Ordered — Quinine,  gr.  ij.  b.d. 


CONVULSIVE   AFFECTIONS.  411 

24th. — Much  better;  free  from  headache;  no  twitching  since  yesterday;  appetite  return- 
ing. Pulse  weak,  80. 

Quinine  and  a  pint  of  porter  daily,  in  addition  to  the  wine. 

This  man  perfectly  recovered,  arid  left  the  hospital  quite  well  soon  after  the  last  report. 

In  fractures  of  the  skull,  the  brain  is  sometimes  lacerated,  and  it  is 
interesting  to  contrast  the  effects  of  this  form  of  lesion,  when  it  is  very 
limited,  with  the  effects  of  concussion  and  compression.- 

The  following  case  is  interesting  and  instructive  in  many  points  of 
view.  As  bearing  on  convulsive  affections  of  the  brain,  it  is  interesting 
inasmuch  as  the  convulsive  attacks  did  not  appear  until  fourteen  days 
after  the  receipt  of  the  injury  ;  the  convulsions  being  most  probably  the 
result  of  the  subsequent  disorganization  and  irritation  of  the  tubular  sub- 
stance of  the  hemispheres.  The  serious  nature  of  the  injury  was  masked 
by  its  small  extent :  this  and  other  points  will  be  adverted  to  when  the 
case  has  been  detailed,  which  is  peculiarly  instructive,  surgically,  as 
bearing  on  the  use  of  the  trephine  (and  to  this  subject  our  attention  must 
also  be  directed) ;  pathologically  and  physiologically,  inasmuch  as  it 
shows  that  convulsions  result,  in  some  cases,  from  lesion  of  tjie  cere- 
brum, and  that  they  are  not  solely  pathognomonic  of  spinal  irritation  and 
disease,  as  stated  by  Dr.  Marshall  Hall. 

Case  77. — John  Wingrove,  set.  33,  a  stone  sawyer,  of  healthy  appearance,  was  admitted 
into  St.  Thomas's  Hospital,  at  a  quarter  before  8  A.M.,  on  April  13th,  1843,  with  a  compound 
fracture  of  the  skull.  The  wound  was  about  two  inches  and  a  half  in  length  on  the  right 
side  of  the  head,  near  the  posterior  extremity  of  the  vertex.  The  scalp  was  completely  divided, 
and  the  bone  perfectly  bare.  The  parietal  bone  was  fractured  in  a  fissured  form ;  a  portion 
of  the  outer  table  being  depressed  so  that  the  fractured  edge  of  the  skull  was  distinct  above 
it.  Some  blood  flowed  from  the  bone,  but  not  much.  A  portion  of  the  leather  lining  of 
his  cap  had  been  driven  into  the  wound,  and  was  nipped  so  closely  by  edges  of  the  bone 
that  it  was  not  easily  removed.  A  small  artery  was  bleeding  on  the  divided  edge  of  the 
scalp.  I  saw  this  man  at  a  quarter  before  9,  about  one  hour  and  a  quarter  after  the  acci- 
dent had  happened.  He  was  quite  sensible ;  both  pupils  acted  perfectly  naturally  to  the  light ; 
he  complained  of  pain  in  his  head,  but  referred  it  principally  to  the  forehead.  There  was 
no  paralysis  of  any  kind ;  pulse  small,  only  60  in  the  minute.  The  accident  occurred  at  the 
New  Royal  Exchange,  and  was  occasioned  by  a  blow  from  the  head  of  a  mason's  hammer 
which  flew  oft' from  the  handle,  and  falling  about  30  feet  struck  him  on  the  head  and  glanced 
off.  He  was  completely  stunned  by  the  blow,  and  had  no  recollection  of  being  put  into  the 
cab  by  which  he  was  conveyed  to  the  hospital,  but  he  recovered  his  senses  before  he  ar- 
rived there. 

I  ordered  Cat.  Lini.  to  the  wound.     Calomel  gr.  v.  3tia  bora, 

\  past  12  P.M. — No  change. 

\  past  10  P.M. — Pulse  80,  but  not  strong;  says  his  head  is  much  better,  but  he  feels  very 
tired,  and  cannot  sleep  ;  but  this  he  is  not  surprised  at,  as  he  never  can  sleep  well  if  he  has 
not  had  his  usual  day's  work. 

He  has  taken  five  doses  of  the  calomel,  and  the  bowels  have  been  copiously  relieved  ; 
as  he  has  no  untoward  symptoms,  I  have  discontinued  the  calomel.  Not  more  than  two 
or  three  ounces  of  blood  have  been  lost  from  the  wound. 

14th. — Going  on  well  in  every  respect;  no  bad  symptoms ;  almost  free  from  pain  in  his 
head  ;  pulse  64 ;  suffers  a  little  from  cough.  Linct.  pro  tussi. 

15th. — Has  had  a  good  deal  of  pain  in  the  forehead,  which  he  attributes  to  the  shaking 
of  his  head  from  the  cough.  His  pulse  86,  but  not  strong ;  loud  respiration  over  the  whole 
chest.  No  pain  in  the  wound  or  neighborhood  ;  bowels  not  open  to-day. 

Ordered— Calomel,  gr.  v.  4ta  hora;  Hirud.  xxx.  lateri capitis  dextro.  Head  shaved.  Pil. 
Ipecac,  c.  Conio.  gr.  v.  6ta  hora.  Emplast.  Lytt.  pectori. 

16th. — Much  better  ;  his  cough  very  much  relieved  ;  free  from  pain  in  his  head  ;  bowels 
not  open  to  day ;  mouth  tender. 

Ordered— M.  S.  C.  stat.     To  omit  the  Cal.till  to-night     A  poultice  to  the  blistered  surface. 

17th,  9  A.M. — Has  had  a  bad  night;  head  very  painful  in  the  frontal  region  ;  pulse  small, 
80;  looks  uncomfortable;  wound  healthy,  suppurating. 

Ordered — Hirud.  xxx.  stat. 


412  HUMAN   BRAIN. 

12  P.M. — better ;  very  little  cough. 

To  omit  the  Pil.  Ipecac,  c.  Conio,  and  to  rep.  Hirud.  h.  n. 

18th. — Much  better  as  regards  his  head,  but  the  cough  still  troublesome. 

To  repeat  the  Ipec.  c.  Conio,  the  blister  on  the  chest  not  having  risen  well;  to  paint  the 
throat  and  chest  with  tincture  of  iodine.  Pulv.  Rhei.  c.  Cal.  gr.  xv.  h.  n. 

19th. — Much  better  in  every  respect. 

20th. — Free  from  pain  in  his  head,  and  the  cough  nearly  gone. 

21st  and  22d. — I  flid  not  see  him. 

23d. — Going  on  well  in  every  respect. 

24th. — Apparently  going  on  well,  but  as  he  still  had  pain  in  the  head,  I  ordered  twenty 
leeches,  and  Pil.  Hydrar.  gr.  v.  bis  in  die. 

25th. — The  same.  Thus  it  appears,  that  for  thirteen  days  after  his  admission,  he  had  not 
a  bad  symptom. 

26th. — I  received  a  message  from  the  dresser,  saying  that  the  man  had  passed  a  bad  night 
and  was  in  a  good  deal  of  pain  in  his  head,  for  which  he  had  applied  twenty  leeches.  I 
saw  him  at  1  P.M.  His  head  has  been  relieved  by  the  leeches,  but  he  complains  of  pain 
at  the  external  angle  of  the  right  orbit,  which  pain  appears  to  him  to  rise  upwards  from  the 
jaw,  and  to  shoot  over  the  head.  He  states  that  he  is  free  from  pain  in  the  neighborhood 
of  the  wound ;  his  mouth  is  tender  from  the  mercury.  As  the  pain  has  so  much  of  a  neu- 
ralgic character,  and  possibly  connected  with  this  salivation,  I  ordered  the  mercury  to  be 
omitted,  and  the  face  to  be  fomented,  after  which  an  ointment  containing  aconite  to  be  rubbed 
into  the  side  of  the  face.  At  5  P.M.,  when  I  saw  him  again,  he  had  been  relieved  by  the 
fomentation,  but  had  not  had  the  ointment,  as  there  was  not  any  aconite  in  the  hospital.  I 
ordered  instead  of  it  equal  parts  of  the  extract  of  belladonna  and  lard,  to  be  made  into  an 
ointment  and  rubbed  into  the  face. 

Pulv.  Jalap,  co.  ^j-  hac  nocte.  M.  S.  C.  eras  mane. 

27th,  12  A.M. — Pulse  80,  soft,  and  rather -weak;  complains  of  his  forehead  and  the  side  of 
the  head,  but  no  pain  in  the  neighborhood  of  the  wound.  His  countenance  was  anxious 
and  distressed ;  the  right  pupil  was  dilated ;  the  left  natural.  I  thought  at  first  that  this 
might  possibly  arise  from  the  application  of  the  belladonna,  but  he  complained  of  having 
lost  the  feeling  in  his  left  hand,  and  that  he  could  not  lay  hold  of  things  so  readily  with  it. 
I  need  hardly  say  I  regarded  this  circumstance  with  the  greatest  concern,  as  I  feared  the 
worst  from  it.  He  had  another  very  serious  symptom,  viz.  that  on  lying  down  he  corn- 
plained  of  his  head  throbbing  violently. 

I  ordered  the  twenty  leeches  to  be  repeated,  and  five  grains  of  blue  pill  twice  a  day;  the 
head  to  be  raised  in  bed.  Immediately  I  quitted  the  ward  I  called  the  attention  of  the  pupils 
who  were  with  me  to  the  serious  character  of  his  symptoms,  and  gave  an  unfavorable  prog- 
nosis. 

At  8  P.M.  I  received  a  message  from  the  dresser,  informing  me  that  he  had  had  a  fit,  and 
when  I  arrived  I  found  him  just  recovering  from  a  third  fit.  The  fits  were  not  preceded  by  any 
scream,  but  in  every  other  respect  they  were  all  of  a  true  epileptic  character.  As  soon  as 
he  began  to  recover  his  senses  he  went  off  again,  and  just  previous  to  this  he  became  very 
violent,  and  was  with  difficulty  retained  in  bed.  I  inquired  of  his  wife  whether  he  had 
ever  been  subject  to  epilepsy :  she  said  no,  but  that  she  had  heard  from  his  mother  that 
when  a  child  he  had  been  subject  to  fits.  Coupling  the  invasion  of  these  fits  with  the  in- 
cipient paralysis  observed  in  the  morning,  I  considered  it  not  impossible  that  there  was  some 
irritation  from  the  internal  surface  of  the  fractured  bone.  I  therefore  determined  to  trephine. 
This  was  accomplished  by  making  first  a  crucial  incision  of  the  integuments,  and  then,  by 
the  application  of  the  trephine  on  the  lower  edge  of  the  fissure  in  the  parietal  bone.  After 
the  removal  of  the  portion  cut  by  the  trephine,  I  removed  with  the  dressing  forceps  a  small 
portion  of  bone  with  a  sharp  edge,  about  the  size  of  a  thumb  nail,  from  under  the  superior 
edge  of  the  fissure  in  the  internal  surface,  which  evidently  pressed  on  the  dura  mater, 
About  eight  ounces  of  blood  were  lost  at  the  operation,  but  very  little  afterwards.  I  per- 
formed it  just  after  the  commencement  of  the  fourth  fit,  as  I  found  he  was  too  excited  after 
he  recovered  from  one  to  permit  any  operation  willingly.  He  had  one  fit  shortly  after  it 
was  completed,  but  no  more  during  the  night.  The  dresser,  Mr.  Fixot,  sat  up  with  him, 
and  he  tells  rne  that  the  patient  complained  of  a  good  deal  of  pain  in  his  head,  referring  it 
principally  to  the  forehead  and  eyebrow,  but  sometimes  to  the  back  part,  near  the  wound; 
he  dozed  at  intervals,  and  then  awoke  with  pain;  pulse  very  variable,  sometimes  thready, 
and  sometimes  a  little  fuller  ;  cough  occasionally  occurred,  always  causing  violent  pain  in  the 
head. 

28th,  9  A.M. — He  has  now  paralysis  of  the  whole  of  the  left  side  of  the  head,  body,  and 
left  extremity. 

He  knows  me :  complains  of  pain  in  his  head,  and  wishes  to  sit  up  in  bed:  we  raised  him, 


CONVULSIVE   AFFECTIONS.  413 

and  then  he  complained  of  being  faint.  I  gave  him  a  very  little  weak  brandy  and  water, 
and  ordered  some  sal  volatile  occasionally.  His  pulse  is  weak  :  100. 

28th,  10  P.M. — Has  had  nine  fits  at  intervals  during  the  day,  the  last  about  half  an  hour 
before  I  came  down;  he  is  quite  sensible  between  the  attacks ;  the  sister  thinks  that  he  has 
lost  some  power  in  the  right  arm.  As  he  was  now  dozing  I  would  not  disturb  him ;  pulse 
80,  small,  but  not  very  feeble ;  skin  hot.  In  one  of  the  fits  the  convulsions  were  very 
slight,  and  confined  to  the  left  side  of  the  body,  and  he  seemed  scarcely  to  lose  his  con- 
sciousness. 1  learned  from  the  sister  that  she  had  observed  twitchings  of  the  muscles  on  the 
left  side  during  the  afternoon  of  yesterday. 

On  Saturday  he  continued  sensible,  and  did  not  appear  to  lose  his  consciousness  even  dur- 
ing the  fits,  for  as  soon  as  the  convulsions  ceased  he  would  take  up  his  handkerchief  and  wipe 
his  mouth.  He  had  fits  every  half  hour,  which  began  at  9  in  the  morning  and  continued 
till  4  in  the  afternoon,  when  twelve  leeches  were  applied  to  his  head,  and  he  had  no  more 
till  11  o'clock  at  night,  when  he  had  a  very  slight  one ;  but  at  12  he  had  a  very  severe  one, 
which  continued  one  hour:  he  was  perfectly  conscious,  and  breathing  natural;  scarcely  ever 
complained  of  his  head,  and  then  referred  the  pain  to  the  right  brow. 

Sunday,  30th. — He  had  no  decided  fits,  only  twitching  of  the  muscles;  remained  sensible 
till  about  4  o'clock  in  the  afternoon,  when  a  great  change  took  place ;  he  turned  very  pale, 
and  had  more  twitching  of  the  muscles,  and  at  twenty  minutes  after  four  had  a  fit, 
which  lasted  an  hour  and  a  half.  After  this  he  totally  lost  the  use  of  his  inferior  extremi- 
ties; all  consciousness  left  him;  he  did  not  have  another  fit,  but  merely  twitching  of  the 
muscles,  and  died  at  twenty  minutes  after  3,  on  the  1st  of  May,  moaning  a  great  deal  and 
making  a  great  noise,  but  for  one  hour  before  he  died  he  never  spoke. 

Post-mortem,  May  1st,  1  P.M. — Head. — After  the  cranium  was  sawn  through,  about  half  an 
ounce  of  yellow  pus  escaped,  while  endeavoring  to  detach  it  from  the  dura  mater.  When 
this  was  done  we  found  the  internal  table  of  the  skull  fractured  more  extensively  than  the 
outer  table,  split  inward  from  the  upper  edge  of  the  fracture.  A  portion  of  this  table  which 
was  thus  split  I  had  removed  with  the  dressing  forceps  after  using  the  trephine.  The  por- 
tions which  remained  could  not  have  been  removed  without  some  force,  as  they  were  only 
partially  separated  from  the  surrounding  bone. 

At  the  time  of  the  operation  I  did  not  detect  this  further  depression,  from  a  fear  of  sepa- 
rating the  dura  mater  more  than  was  absolutely  necessary.  But  the  appearance  of  this  bone 
certainly  teaches  us  that  we  are  warranted  in  such  cases  (even  in  the  absence  of'depression 
of  the  outer  table,  and  the  removal  of  the  portions  which  are  found  at  the  edge  of  the  open- 
ing made  by  the  trephine),  in  searching  carefully  for  any  further  portions  that  may  have 
been  separated. 

Opposite  this  fracture  there  was  a  small  opening  in  the  dura  mater  of  the  size  and  shape 
of  the  extremity  of  the  nail  of  the  little  finger,  through  which  some  softened  brownish-co- 
lored brain  was  exuding,  On  turning  back  the  dura  mater,  we  found  on  the  same  side  the 
whole  surface  of  the  arachnoidea  investiens  covered  with  healthy  yellow  pus.  The  arach- 
noidea  reflexa  lining  the  dura  mater  was  coated  with  a  thick  layer  of  pus,  so  tenacious  that 
it  almost  amounted  to  a  false  membrane. 

The  brain,  corresponding  to  the  seat  of  fracture,  was  much  discolored.  The  centre  of 
discoloration  was  of  a  dark,  dirty-brownish  hue,  of  a  semi-liquid  consistency,  gradually  be- 
coming firmer,  and  shaded  off  to  a  dingy  pinkish  color  towards  the  circumference,  which 
was  spotted  with  deep  bloody  points :  a  horizontal  section  of  the  brain  about  half  an  inch 
from  the  surface  showed  this  very  distinctly.  The  disorganization  extended  downwards  into 
the  lateral  ventricle  at  the  commencement  of  the  descending  and  posterior  cornua,  involving 
a  portion  of  the  transverse  commissure,  but  not  either  the  thalamus  or  corpus  striatum.  The 
surface  of  the  brain,  where  the  arachnoidea  had  been  covered  with  pus,  was  slightly  softened 
in  many  places,  but  most  so  over  the  inferior  edge  of  the  anterior  lobes  of  the  right  hemi- 
sphere. 

The  hemispherical  ganglion  was  scarcely,  if  at  all,  altered  in  its  condition:  its  color  was 
healthy,  neither  paler  nor  deeper  than  usual ;  the  edge,  in  some  situations,  was  converted 
into  a  grayish-greenish  tint,  which  Dr.  Hodgkin  attributed  to  a  post-mortem  action  of  sulphuretted 
hydrogen. 

The  pia  mater  and  arachnoid  on  the  left  hemisphere  were  both  perfectly  healthy,  and 
also  on  the  surface  of  both  hemispheres,  where  they  are  in  contact  with  the  falx  major. 

If  the  nature  of  the  fracture  in  this  case,  and  the  injury  inflicted  on 
the  brain  and  its  membranes,  as  demonstrated  by  this  post-mortem  ex- 
amination, could  have  been  ascertained  at  the  time  of  his  admission,  no 
one  could  have  hesitated  to  use  the  trephine.  Some  fifty  or  sixty  years 
ago  the  trephine  would  have  been  immediately  applied  with  the  view  of 


414  HUMAN    BRAIN. 

elevating  the  depressed  portion.  This  operation,  however,  in  the  pre- 
sent da)7,  is  not  as  a  general  rule  considered  justifiable  in  the  absence  of 
symptoms  of  compression,  or  direct  irritation  of  the  brain.  It  is,  then, 
a  question  for  consideration  why  this  condition  was  not  detected,  and 
how  far  it  would  be  desirable  to  adopt  a  different  course  when  a  similar 
case  comes  before  us. 

As  a  post-mortem  examination  does  not  demonstrate  the  amount  of 
lesion  of  the  brain  at  the  time  of  his  admission,  for  much  that  we  now 
observe  is  the  result  of  subsequent  inflammation  and  gangrene,  let  us 
endeavor,  reasoning  from  other  cases  and  the  physiology  of  the  subject, 
to  establish  this  point. 

In  the  examination  of  a  case  of  this  kind,  during  life,  it  is  extremely 
important  to  enter  minutely  into  all  those  signs  which  indicate  any  injury 
to  the  brain.  First,  the  mental  condition — this  was  perfectly  normal  ; 
he  was  quite  sensible,  and  his  manner  natural.  Next,  the  state  of  the 
pupils — the  iris  is  placed  before  that  expanded  surface  of  the  optic  nerve, 
the  retina,  as  an  intelligent  curtain  to  guard  it  from  injury.  The  vital 
contrivances  by  which  it  acts,  and  by  which  its  action  is  directed,  are 
so  beautifully  perfect,  that  the  extent  of  the  opening  of  the  curtain  is  in- 
dicative of  the  state  of  the  nervous  apparatus  it  is  destined  to  protect, 
by  preventing  such  an  amount  of  light  impinging  upon  it  as  would  be 
liable  to  injure  it.  In  disease  of  the  globe  of  the  eye,  the  dilated  pupil 
indicates  more  or  less  pressure  on  the  retina  by  some  cause  in  the  globe 
itself,  such  as  a  permanently  turgid  choroid,  &c.  But  if  with  a  healthy 
eye,  and  in  connection  with  a  blow  on  the  head,  we  find  a  dilated  pupil, 
then  we  have  the  sign  of  some  pressure  or  injury  to  the  nerve  in  its 
course  within  the  skull,  or  the  ganglia  in  which  it  terminates. 

The  dilated  pupil,  then,  indicates  very  serious  injury  to  the  optic 
nerve,  or  the  nervous  centres  with  which  it  is  connected,  though  it  may 
happen,  as  in  the  case  of  very  severe  concussion,  that  the  injury  is  re- 
mediable. The  contracted  pupil,  on  the  contrary,  indicates  an  irrita- 
bility of  the  nervous  instruments,  an  undue  excitement  of  their  natural 
function,  not  an  obliteration  of  it.  You  will  sometimes  see,  in  the  case 
of  injury  of  the  brain,  dilatation  of  one  pupil  and  contraction  of  the  other; 
where  this  is  the  case  you  will  find  the  most  severe  injury  of  the  brain 
on  the  side  opposite  the  dilated  pupil,  as  occurred  in  this  case  from  sub- 
sequent inflammation  and  softening. 

The  next  point  to  which  ray  attention  was  directed  in  reference  to  the 
prognosis  of  the  case,  was  the  state  of  the  wound,  and  the  blood  which 
flowed  into  it.  Now  the  blood  which  flowed  into  the  depression  might 
be  from  a  wounded  artery  of  the  dura  mater,  or  simply  from  the  bone. 
If  from  the  dura  mater,  the  injury  was  of  course  very  serious:  this  I 
hoped,  and  believed,  from  its  extent  at  the  time,  was  not  the  case.  It 
soon  ceased,  which  gave  me  reason  to  hope  that  the  inner  table  was  not 
fractured.  That  the  outer  table  may  be  fractured  without  the  inner,  has 
long  been  known.  We  have  a  very  good  preparation  in  the  Museum  at 
St.  Thomas's,  where  there  is  considerable  depression  of  the  outer  with- 
out any  whatever  of  the  inner  table.  But  the  post-mortem  examination 
proved  that  at  the  time  of  his  admission,  the  internal  table  of  the  skull 
was  more  extensively  fractured  than  the  outer,  and  that  the  fractured 


CONVULSIVE   AFFECTIONS.  415 

portions  were  partially  depressed,  notwithstanding  the  entire  absence  of 
all  symptoms  of  compression.  These  symptoms,  as  almost  universally 
agreed  to  by  surgeons,  consist  of  an  entire  loss  of  consciousness;  the 
mental  faculties  are  smothered,  and  they  cannot  be  roused.  Many  of  the 
functions  of  vegetative  life  are  also  interfered  with — the  breathing  is 
laborious  and  stertorous,  not  unfrequently  the  sphincters  are  relaxed,  and 
the  excretions  are  evacuated  involuntarily.  There  are  sometimes  other 
symptoms,  but  these  are  the  most  common. 

It  may  be  said,  if  such  are  the  symptoms  of  compression,  why  were 
they  entirely  absent  in  this  case,  where  the  inner  table  was  depressed 
and  driven  in  upon  the  brain  ?  I  am  inclined  to  believe  that  the  acknow- 
ledged symptoms  of  compression  depend  upon  the  extent  of  the  hemi- 
spherical ganglion  which  is  pressed  upon  suddenly,  and  that  if  only  a 
very  small  portion  of  this  ganglion  is  pressed  upon,  then  its  functions 
are  not  naturally  impaired,  in  this  case,  and  many  others  that  might  be 
quoted  :  nevertheless,  you  must  not  consider  it  more  than  an  hypothesis 
of  ray  own,  and  not  as  an  established  principle,  but  I  conceive  this  is 
the  only  truly  physiological  explanation  of  this  apparent  anomaly. 

The  splintered  portion  of  the  skull  lacerated  the  dura  mater  to  a  very 
small  extent,  and  to  about  the  same  extent,  but  no  more,  was  the  hemi- 
spherical ganglion  originally  injured.  The  medullary  or  fibrous  sub- 
stance beneath  was  so  shaken  that  blood  was  effused  in  small  points,  as 
may  sometimes  be  observed  in  cases  of  simple  concussion  without  frac- 
ture. On  referring  to  treatises  on  injuries  of  the  head,  I  have  been  sur- 
prised to  find  so  many  cases  recorded  in  which  very  serious  injuries  to 
the  brain  have  been  unattended  by  serious  symptoms  of  disturbed  intel- 
lect ;  but,  as  far  as  I  can  judge  from  the  loose  mode  in  which  post-mor- 
tem appearances  are  almost  invariably  detailed,  they  are  all  cases  in 
which  the  injury  is  confined  to  the  base  of  the  brain,  or  the  hemispheri- 
cal ganglion  has  been  but  slightly  injured  in  the  first  instance.  It  is  a 
pity  that  surgeons  who  have  written  on  this  subject  should  have  neglected 
to  state  the  exact  extent  of  the  surface  injured,  for  this  fact  is  equally 
important  in  its  physiological  as  it  is  in  its  pathological  bearing ;  the 
ignorance  of  it  having  induced  some  well-meaning  but  foolish  people  to 
quote  such  uses  in  proof  of  their  theory  that  the  brain  is  not  the  organ 
of  the  mind — not  distinguishing  between  the  ganglion  which  is  connected 
with  the  mind,  and  those  which  are  not.  The  following  case,  quoted 
by  Mr.  Guthrie  from  Dupuytren,  illustrates  my  view  of  this  subject. 

A  young  man  had  received  a  wound  in  the  head  from  a  knife,  which 
healed  in  the  usual  way,  leaving  only  a  little  pain  which  occurred  occa- 
sionally round  the  cicatrix.  Some  years  after,  he  was  brought  to  the 
Hotel  Dieu  in  a  state  of  stupefaction,  with  which  he  had  been  suddenly 
seized.  An  incision  having  been  made  through  the  cicatrix,  the  point 
of  a  knife  was  seen  sticking  in  the  bone,  the  removal  of  which  gave  no 
relief.  The  trephine  was  then  applied  without  any  result.  The  para- 
lysis continuing  on  the  opposite  side  to  that  on  which  the  wound  had 
been  received,  it  was  thought  right  to  open  the  dura  mater,  arid  then  to 
plunge  the  knife  into  the  brain,  when  a  large  quantity  of  pus  escaped. 
The  paralysis  ceased  that  night ;  he  recovered  his  speech,  became  sen- 
sible, and  entirely,  though  gradually,  recovered. 


416  HUMAN   BRAIN. 

In  this  case  we  may  conclude,  from  the  account,  that  the  ganglion  was 
only  injured  to  the  extent  of  the  breadth  and  thickness  of  the  knife,  and 
no  disturbance  of  the  mind  followed  until  an  abscess  formed,  which, 
pressing  on  the  ganglion  from  within,  indicated  its  presence  by  the  stupe- 
faction and  paralysis  that  followed. 

The  evacuation  of  the  matter  relieved  the  pressure,  the  senses  re- 
turned, and  the  paralysis  ceased. 

Whether  this  explanation  of  the  fact  that  we  meet  with  cases  of  de- 
pression of  the  table  of  the  skull  without  the  ordinary  signs  of  compres- 
sion of  the  brain,  be  true  in  its  physiology  or  not,  the  fact  itself  is  a  most 
important  one  to  be  remembered  for  its  practical  bearings. 

On  referring  back  to  its  progress,  it  will  be  seen  that  on  the  8th,  9th, 
and  10th  days  after  the  accident,  he  was  almost  free  from  untoward 
symptoms :  so  well  indeed  had  the  case  gone  on,  that  my  friend  Mr. 
Travers,  who  had  watched  it  with  some  interest,  congratulated  me  on 
the  favorable  result  of  the  anticipatory  treatment  which  I  had  adopted. 
It  may  be  fairly  considered  that  these  antiphlogistic  measures,  which 
were  practised  so  early,  stayed  for  the  time  the  invasion  of  inflammatory 
action,  though  they  did  not  entirely  arrest  it.  His  system  was  brought 
under  the  influence  of  mercury  within  24  hours  of  the  occurrence  of  the 
injury,  and  though  he  was  not  bled  from  the  arm,  for  he  never  had  a  pulse 
exhibiting  sufficient  vascular  action  to  justify  it,  148  leeches  were  applied 
to  the  head. 

The  cough  was  much  subdued  by  the  ipecacuanha  and  conium  pill,  a 
blister,  and  the  tincture  of  iodine  to  the  chest. 

But  still  the  mischief  went  on,  and  thus  I  believe  the  fibrous  medulla 
beneath  the  hemispherical  ganglion  became  softened,  as  indicated  on  the 
eleventh  day,  by  slight  loss  of  sensation  in  the  left  hand.  If  the  medulla 
had  been  materially  altered  in  its  texture,  at  the  time  of  his  admission, 
by  the  blow,  there  must  have  been  paralysis  at  that  time,  and  the  fact 
of  its  not  appearing  till  the  eleventh  day  shows  how  slowly  the  softening 
and  disorganization  must  have  proceeded.  The  softening  increased,  and 
then  an  epileptic  fit  takes  place,  quickly  succeeded  by  another,  and 
another,  and  another,  until,  by  means  of  openings  made  with  the  trephine, 
a  splinter  of  bone  was  removed. 

The  principal  cause  of  irritation  is  removed,  and  one  more  fit  occurs 
immediately,  and  then  they  cease  for  about  twelve  hours,  when  they 
again  recur,  and  though  occasionally  stopped  for  a  short  period  by  local 
blood-letting,  they  return  at  intervals,  until  the  patient  becomes  quite 
insensible,  remaining  so  for  twelve  hours  previous  to  his  death.  This 
loss  of  consciousness  I  attribute  to  the  pus  we  found  effused  on  the  sur- 
face of  the  brain,  for  until  the  pus  was  effused  there  was  nothing  to  in- 
terfere with  the  hemispherical  ganglion,  and  therefore  nothing  to  affect  the 
intellect ;  and  neither  the  quantity  nor  quality  of  the  pus  was  such  as  might 
not  have  been  effused  in  the  course  of  twelve  or  fifteen  hours  at  the 
longest.  I  think  the  inflammatory  action  which  caused  it  was  occasioned 
by  the  epileptic  fits,  and  not  the  cause  of  them.  The  cause  of  the  fits 
I  believe  is  to  be  found  in  the  softening  and  gangrene  of  the  fibrous  or 
conducting  substance  of  the  brain. 

Taking  this  view  of  the  progress  of  the  case,  I  cannot  avoid  the  con- 


CONVULSIVE    AFFECTIONS.  417 

elusion  (hat  if  this  patient  had  been  trephined  when  he  was  first  admitted, 
he  would  have  had  a  better  chance  of  recovery  than  by  postponing  it; 
and  though  it  is  impossible  to  say  whether  the  brain  was  or  was  not  so 
much  injured  at  first  as  to  have  been  irremediable,  I  candidly  confess  that 
I  do  not  believe  it  was  ;  for  if  such  had  been  the  case  there  must  have 
been  some  symptoms  of  such  a  lesion,  though  it  is  astonishing  from  what 
serious  lesion,  both  primary  and  secondary,  the  brain  will  recover.  I 
believe  that  almost  all  the  disorganization  which  the  post-mortem  exami- 
nation exhibited  in  the  right  hemisphere  of  the  brain  was  the  result  of 
inflammatory  action,  excited  by  the  irritation  of  the  fractured  skull,  and 
partly  kept  up  and  aggravated  by  the  concussions  occasioned  by  the 
cough.  The  number  of  cases  on  record  in  which  patients  have  recovered 
whose  brains  have  been  seriously  wounded,  when  the  cause  of  irritation 
has  been  removed,  should  encourage  us  to  make  the  attempt  as  early  as 
possible  to  remove,  if  we  can  discover  on  what  it  depends.  The  dif- 
ficulty in  the  present  case  was  to  ascertain  the  fact  of  depression  of  the 
internal  table. 

There  is  no  point  in  surgical  practice  regarding  which  there  is  and 
has  been  so  much  difference  of  opinion  as  the  use  of  the  trephine.  Mr. 
Abernethy's  Treatise  on  Injuries  of  the  Head  was  called  forth  in  con- 
sequence of  the  difference  of  opinion  regarding  the  line  of  practice  that 
ought  to  be  followed  in  particular  cases.  He  relates  seven  cases  of 
fracture,  with  depression,  which  occurred  within  one  twelvemonth  at 
St.  Bartholomew's,  that  recovered  without  any  operation,  "  showing  that 
a  slight  degree  of  pressure  does  not  derange  the  functions  of  the  brain, 
for  a  limited  period  at  any  rate,  after  its  application."  After  relating 
other  cases,  he  goes  on  to  say — "  Such  cases  ought  to  deter  surgeons 
from  elevating  the  bone  in  every  instance  of  slight  depression,  since  by 
the  operation  they  must  inflict  a  further  injury  upon  their  patients,  the 
consequence  of  which  it  is  impossible  to  estimate.  From  all,  therefore, 
that  I  have  learned  from  books,  as  well  as  from  the  observations  I  have 
made  in  practice  and  from  reasoning  upon  the  subject,  I  am  disposed  to 
join  in  opinion  with  those  surgeons  who  are  against  trephining  in  slight 
depressions  of  the  skull,  or  small  extravasations  of  the  dura  mater." 

Benjamin  Bell,  whose  System  of  Surgery  was  published  in  1801, 
says,  "  Hitherto  it  has  been  a  general  rule  to  consider  the  application  of 
the  trepan  as  necessary  in  every  fissure,  whether  any  symptoms  of  a  com- 
pressed brain  have  occurred  or  not ;  but  due  attention  to  the  real  na- 
ture of  the  fissure,  and  to  the  effects  most  likely  to  result  from  perforating 
the  skull,  will  show,  that  although  fissures  may  be  frequently  combined 
with  such  symptoms  as  require  the  trepan,  yet  they  are  not  always, 
or  necessarily  so  ;  and,  unless  when  such  symptoms  actually  exist,  that 
this  operation,  instead  of  affording  relief,  must  frequently  do  harm  ;  for 
it  is  by  no  means  calculated  for,  or  in  any  respect  adequate  to,  the  pre- 
vention of  these  symptoms,  and  I  have  already  endeavored  to  show  that 
laying  the  brain  bare  is  never  to  be  considered  as  harmless,  and,  there- 
fore, that  it  should  never  be  advised  but  where  it  is  probable  that  some 
advantage  may  be  derived  from  it."  In  the  present  day  these  observa- 
tions of  Mr.  Bell  seem  almost  superfluous,  but  when  we  find  such  pre- 
cepts as  the  following  inculcated  by  John  Hunter  in  his  Surgical  Lec- 
27 


418  HUMAN    BRAIN. 

tures,  we  need  not  be  surprised  that  subsequent  teachers  of  surgery 
should  have  felt  the  necessity  of  warning  their  pupils  against  the  too  free 
use  of  the  trephine.  "  As  we  cannot  tell  for  certain  at  the  time,"  says 
Mr.  Hunter,  u  whether  the  symptoms  arise  from  concussion,  compres- 
sion, or  from  extravasation  of  blood,  it  may  be  more  advisable  to  trepan, 
as  the  operation  can  do  no  harm" 

Mr.  Lawrence  relates  an  interesting  case  in  a  clinical  lecture,  pub- 
lished in  the  Medical  Gazette,  vol.  xxi.  p.  345,  of  a  boy  who  recovered 
without  operation,  in  whom  the  skull  was  fractured  and  depressed,  the 
brain  wounded,  and  portions  of  it  extravasated  through  a  laceration  of 
the  scalp.  "In  this  case,"  Mr.  Lawrence  says,  "  as  the  bone  was  here 
evidently  and  considerably  depressed,  and  as  it  was  also  probably  driven 
in  upon  the  brain,  it  would,  I  believe,  have  accorded  with  the  princi- 
ples of  treatment  generally  admitted,  to  have  performed  an  operation  for 
the  purpose  of  elevating  and  removing  depressed  and  detached  portions 
of  the  bone." 

"  The  considerations  which  determined  me  to  do  this  were,  the  favor- 
able state  of  the  patient  generally,  and  in  particular  the  absence  of  all 
symptoms  indicating  compression  of  the  brain  ;  the  specimens  in  patho- 
logical collections,  of  very  extensive  injuries  of  the  skull  repaired  by  a 
natural  process  ;  the  smallness  of  the  external  wound,  which  brought 
this  case  nearly  into  the  state  of  simple  fracture  ;  the  extensive  incision 
of  the  integuments,  and  exposure  of  the  bone,  dura  mater,  and  brain, 
which  an  operation  would  have  involved  ;  and  the  almost  invariably 
fatal  termination  of  such  proceedings  within  my  own  experience  in  hos- 
pital practice." 

Dr.  Hennen,  in  his  admirable  work  on  Military  Surgery,  relates  many 
cases  to  show  that,  in  the  absence  of  symptoms,  the  trephine  should  not 
be  used,  even  when  the  bone  is  evidently  depressed.  He  says,  p.  288  : 
"  We  have  here  sufficient  proof  that  there  is  no  absolute  necessity  for 
trepanning  merely  for  depressed  bones  from  gunshot,  although  few  would 
be  so  hardy  as  not  to  remove  all  fragments  that  came  easily  and  readily 
away." 

All  the  cases  which  Dr.  Hennen  relates  are  well  worthy  of  perusal, 
but  I  have  only  room  to  quote  one  short  history  in  connection  with  the 
present  case.  "  A  soldier  was  shot  in  the  head  in  the  Canadian  cam- 
paign. A  fracture  was  the  consequence,  with  a  depression  of  not  less 
than  an  inch  and  a  half;  but  as  no  untoward  symptom  occurred,  no  ope- 
ration was  had  recourse  to.  The  man  recovered,  and  went  to  the  rear, 
where,  at  a  distance  of  several  weeks  afterwards,  he  got  an  attack  of 
phrenitis  from  excessive  drinking,  and  died.  As  the  existence  of  the 
ball  in  the  brain  was  strongly  suspected,  an  inquiry  was  made  after 
death,  and  on  dissection  it  was  found  lodged  in  the  corpus  callosum." 

Mr.  Gtithrie,  in  his  interesting  and  valuable  work  on  Injuries  of  the 
Head,  lately  published,  makes  some  excellent  remarks  on  the  best  mode 
of  proceeding  in  these  obscure  cases.  **  The  inner  table  (says  Mr. 
Guthrie)  is  sometimes  broken  in  a  peculiar  manner,  to  which  I  believe 
attention  has  only  been  drawn  by  myself  in  my  lectures,  since  trepanning 
has  ceased  to  be  the  rule  in  all  cases  of  fracture.  In  these  cases  the 
skull  is  cut  rather  than  broken  by  a  sharp  cutting  instrument,  such  as  an 


CONVULSIVE   AFFECTIONS.  419 

axe,  sword, "&c.,  just  in  fact  as  a  piece  of  wood  might  be,  while  the  in- 
ner table,  like  a  piece  of  glass  or  brittle  steel,  is  broken  and  splintered 
inwards.  u  These  cases  should  be  examined  carefully.  The  length  of 
the  wound  on  the  top,  or  side,  or  any  part  of  the  head  which  is  curved 
and  not  flat,  will  readily  show  to  what  depth  the  sword  or  axe  has  pene- 
trated. A  blunt  or  flat  ended  probe  should  in  such  cases  be  carefully 
passed  into  the  wound,  and  being  gently  pressed  against  one  of  the  cut 
edges  of  the  bone,  its  thickness  may  be  measured,  and  the  presence  or 
absence  of  the  inner  table  may  thus  be  ascertained.  If  it  should  be 
separated  from  the  diploe,  the  continued  but  careful  insertion  of  the 
probe  will  detect  it  deeper  in  the  wound  ;  a  further  careful  investigation 
will  show  the  extent  in  length  of  this  separation,  although  not  in  width, 
and  will,  in  all  probability,  satisfy  the  surgeon  that  those  portions  of 
bone  which  have  thus  been  broken  and  driven  in  are  sticking  in  or  irri- 
tating the  brain.  In  many  such  cases  there  has  not  been  more  than  a 
momentary  stunning  felt  by  the  patient ;  he  says  he  is  free  from  symp- 
toms, that  he  is  not  much  hurt,  and  is  satisfied  he  shall  be  well  in  a  few 
days." 

"  An  officer  was  struck  on  the  head  in  Halifax,  Nova  Scotia,  by  a  drunken 
woman  with  a  tomahawk  or  small  Indian  hatchet,  which  made  a  per- 
pendicular cut  into  his  left  parietal  bone  and  knocked  him  down.  As 
he  soon  recovered  from  the  blow,  and  suffered  nothing  but  the  ordinary 
symptoms  of  a  common  wound  of  the  head  with  fracture,  it  was  con- 
sidered to  be  a  favorable  case,  and  was  treated  simply,  although  with 
sufficient  precaution.  He  sat  up  and  shaved  himself  until  the  fourteenth 
day,  when  he  observed  that  the  corner  of  his  mouth  on  the  opposite 
side  to  that  on  which  he  had  been  wounded  was  fixed,  and  the  other 
drawn  aside,  and  that  he  had  not  the  free  use  of  the  right  arm,  so  as  to 
enable  him  to  shave.  He  was  bled  largely,  but  the  symptoms  increased 
until  he  lost  the  use  of  the  right  side,  became  comatose,  and  died.  On 
examination  the  inner  table  was  found  broken,  separated  from  the  diploe, 
and  driven  into  the  brain,  which  was  at  that  part  soft,  yellow,  and  in  a 
state  of  suppuration."  After  relating  several  other  instructive  cases 
bearing  on  this  point,  he  says:  "  The  principle  being  laid  down  that  it  is 
right  and  proper  to  examine  all  such  wounds  with  a  blunt  flat  probe,  in 
order  to  ascertain,  if  possible,  whether  the  inner  table  is  depressed  or 
broken,  the  question  necessarily  arises,  what  is  to  be  done  when  such 
depression  and  breaking  down  of  the  inner  table  are  ascertained  to  have 
taken  place?  There  can  be  no  hesitation  in  answering  that  in  all  such 
cases  the  trephine  should  be  applied,  although  no  symptoms  should  exist, 
with  the  view  of  anticipating  them." 

1  The  old  doctrine,  it  may  be  said,  in  regard  to  fractures  generally, 
is  revived  in  these  cases,  but  on  a  principle  with  which  our  predecessors 
were  not  sufficiently  acquainted.  A  patient  very  often  survives  a  mere 
depression  of  the  skull ;  he  may,  and  occasionally  does,  survive  a  greater 
depression  of  the  inner  than  the  outer  table;  but  I  do  not  believe  that 
he  ever  does  survive  and  remain  in  tolerable  health,  after  a  depression 
with  fracture  of  the  inner  table,  when  portions  of  it  have  been  driven 
into  the  dura  mater.  If  cases  could  be  advanced  of  complete  recovery 
after  such  injuries,  I  should  not  consider  them  as  superseding  the  prac- 


420  HUMAN    BRAIN. 

tice  recommended,  unless  they  were  so  numerous  as  to  establish  the 
fact  that  wounds  of  the  dura  mater  and  brain  are  not  extremely  dangerous. 
I  have  referred  purposely  to  many  cases  in  which  a  cure  was  effected 
after  a  lapse  of  time  by  the  bone  being  removed  ;  but  they  rather  sup- 
port than  invalidate  the  principle  I  have  inculcated.  There  are  great 
objections,  I  admit,  to  the  trephine  being  applied  in  ordinary  cases  of 
fracture,  which  are  not  attended  by  symptoms  of  further  mischief;  but 
the  nature  of  the  cases  which  I  have  particularly  referred  to  having  been 
ascertained,  I  maintain  that  the  practice  should  be  promp  and  decisive 
in  every  instance  in  wrhich  the  surgeon  is  satisfied  that  there  is  not  merely 
a  slight  depression  or  separation  of  the  inner  table,  but  that  several  points 
of  it  are  driven  into  the  dura  mater.'' 

I  have  thought  it  incumbent  on  me  to  dwell  very  fully  on  the  justifi- 
ableness  of  the  use  of  the  trephine  in  such  fractures  of  the  skull  where 
there  is  an  absence  of  cerebral  symptoms.  Nevertheless,  I  cannot  re- 
commend the  use  of  the  trephine  in  any  case,  unless  there  ia*very  de- 
cided evidence  of  a  wounded  dura  mater  from  splintered  portions  of  the 
inner  table.  "  If  there  be  any  doubt,"  says  the  same  authority,  u  on 
the  mind  of  the  surgeon  whether  there  are,  or  are  not,  any  portions  de- 
pressed and  irritating  the  brain  or  its  membranes,  he  should  wait ;  and 
in  this  it  is  that  the  real  difference  between  modern  surgery  and  that  of 
the  olden  time  exists,  with  respect  to  adults." 

The  nature  of  the  fracture  in  this  case  rendered  it  almost  impossible 
to  ascertain  the  fact  of  fracture  of  the  inner  table  by  means  of  the  probe, 
as  recommended  by  Mr.  Guthrie. 

It  will  be  perceived,  from  these  few  quotations,  that  there  is  still  con- 
siderable difference  of  opinion  as  to  any  general  rule  for  the  use  of  the 
trephine  in  fracture  of  the  skull.  It  must,  indeed,  be  admitted  that  no 
general  rule  can  be  laid  down,  but  that  every  surgeon  must  be  guided 
by  the  peculiar  circumstances  of  each  particular  case,  bearing  in  mind 
that  there  are  cases  of  injury  of  the  brain  in  which  the  trephine  may  be 
required,  though  all  the  symptoms  of  compression  are  absent.  Such 
cases,  it  is  true,  are  rare,  and  their  diagnosis  difficult,  but  it  is  only  by 
the  remembrance  of  their  occasional  existence  that  we  ever  detect  them. 

And,  on  the  other  hand,  scarcely  any  extent  of  wound  of  the  skull, 
the  brain,  and  its  membranes,  accompanied  with  unequivocal  depression 
of  bone,  should  dissuade  from  the  operation,  if  the  functions  of  vegeta- 
tive life  are  not  so  seriously  interfered  with  as  to  make  a  fatal  result  in- 
evitable ;  for  the  records  of  surgery  teem  with  cases  showing/rom  what 
serious  injury  of  the  brain  some  patients  will  recover. 

The  next  practical  point  which  the  consideration  of  this  case  suggests, 
is,  whether  we  are  justified  in  opening  the  dura  mater  when  it  has  been 
exposed  by  the  trephine,  in  those  cases  in  which  there  are  symptoms  of 
pus  beneath  its  surface. 

The  dura  mater,  when  exposed  by  the  removal  of  a  portion  of  the 
skull,  will  be  seen  to  rise  and  fall  wilh  the  pulsations  of  the  brain,  if  it 
is  not  separated  from  the  dura  mater  by  anything  else  than  the  other  in- 
vesting'membranes.  It  is  true  that  in  a  tranquil  state,  and  with  a  small 
opening,  the  motion  is  very  slight.  The  absence  of  this  motion  is  stated 
by  Mr.  Guthrie  as  diagnostic  of  fluid  beneath.  "I  have  seen,"  says 


CONVULSIVE  AFFECTIONS.  421 

this  author,  "  on  the  removal  of  a  portion  of  bone,  the  dura  mater  rapidly 
rises  up  into  the  opening,  so  as  to  attain  nearly  the  level  of  the  surface  of 
the  skull,  totally  devoid,  however,  of  that  pulsatory  motion  which  usually 
marks  its  healthy  state  ;  and  an  opening  into  it  under  these  circumstances 
has  allowed  a  quantity  of  purulent  matter  to  escape,  proving  that  the 
unnatural  elevation  of  the  dura  mater  was  caused  by  the  resiliency  of  the 
brain,  when  the  opposing  pressure  of  the  cranium  was  removed.  I  con- 
sider this  tense  elevation,  and  the  absence  of  pulsation,  to  be  positive 
signs  of  there  being  a  fluid  beneath  requiring  an  incision  into  the  dura 
mater  for  its  evacuation.  It  is  a  point  scarcely,  if  at  all,  noticed  in 
English  surgery,  although  much  insisted  on  in  France.  It  was  not  in 
the  slightest  degree  understood  till  the  commencement  of  the  war  in  the 
Peninsula,  and  was  one  of  those  points  which  particularly  attracted  my 
attention." 

In  Wingrove's  case,  no  such  phenomena  were  exhibited  at  the  time 
of  the  operation,  nor  did  I  perceive  it  when  I  examined  the  wound  at 
my  daily  visits,  which  would  rather  confirm  the  opinion  that  the  pus 
was  not  effused  until  about  twelve  or  fifteen  hours  before  death. 

If  I  had  observed  this  sign  of  the  presence  of  matter  under  the  dura 
mater,  I  confess  that  I  should  have  punctured  it,  though  I  cannot  believe, 
from  the  post-mortem  examination,  that  the  operation  would  have  altered 
the  result,  as  nothing  could  have  changed  the  gangrenous  condition  of 
the  brain.  There  are  many  other  points  of  interest  connected  with  in- 
juries of  the  skull,  and  the  use  of  the  trephine,  not  bearing  upon  the 
present  subject,  which  I  shall  notice  in  another  place. 

I  cannot  conclude  these  remarks  without  again  adverting  to  the  im- 
portance of  making  a  very  careful  diagnosis  and  prognosis  in  all  injuries 
of  the  skull ;  and  that  while  we  value  the  trephine  and  elevator  as  most 
useful  instruments  for  the  relief  of  a  compressed  and  irritated  brain,  we, 
must  never  be  tempted  by  the  prospect  of  performing  what,  if  successful, 
is  certainly  a  brilliant  operation,  but  blamefully  mischievous  if  the  con- 
dition of  the  parts  should  not  absolutely  require  it,  without  having  first 
a  well-grounded  conviction  that  its  use  can  alone  save  the  life  of  our 
patient ;  remembering  that  in  all  such  injuries  the  great  danger  to  be 
apprehended  is  inflammation  of  the  brain  and  its  membranes,  and  that 
nothing  is  so  likely  to  produce  it  as  their  exposure  to  the  air,  and  the 
forcible  removal  of  their  natural  protectors. 

The  next  case  is  one  of  great  interest  in  every  point  of  view.  I  have 
never  seen  convulsions  following  injury  to  the  brain  of  such  frequencv 
and  severity  which  have  been  survived.  That  the  cerebral  lesion  must 
have  been  very  serious,  is  proved  by  the  paralysis  of  the  arm  and  leg. 
In  a  therapeutical  point  of  view,  it  is  important  to  observe  how  obsti- 
nate the  symptoms  were  until  the  system  was  influenced  by  the  mer- 
cury. I  have  no  doubt  but  that  the  blood-letting  arrested  the  inflamma- 
tory action  until  the  mercury  performed  its  work,  but  it  did  not  appear 
as  if  the  blood-letting  alone  could  control  the  disease. 

Case  78. — Thomas  Smith,  a  boy  set.  14,  residing  at  Woolwich,  was  admitted  into  George's 
Ward,  May  1 1th,  1846,  under  the  care  of  Mr.  Solly,  with  a  severe  injury  of  the  head. 

It  was  stated  that  he  had  fallen  from  a  scaffolding  twenty  feet,  or  upwards,  in  height, 
pitching  upon  his  head;  when  picked  up,  was  quite  insensible,  and  there  was  bleeding 
from  the  right  ear. 


422  HUMAN    BRAIN. 

The  accident  occurred  at  7  A.  M.,  and  he  was  at  once  sent  to  the  Hospital. 

Mr.  Solly  saw  him  at  half-past  9,  when  he  was  still  insensible,  and  evidently  suffering 
from  a  severe  concussion  of  the  brain.  His  head  was  directed  to  be  shaved,  a  cold  lotion 
to  be  applied,  and  warmth  to  the  extremities;  and  five  grains  of  calomel  were  given  im- 
mediately. 

At  half-past  1  he  was  again  seen  by  Mr.  S.,  when  he  had  recovered  his  senses,  but  was  very 
drowsy,  and  complained  of  pain  in  his  head ;  the  pulse  was  somewhat  slow  and  laboring, 
the  pupils  dilated,  particularly  the  left,  but  contracted  upon  the  admission  of  light.  He  was 
ordered  to  take  two  grains  of  calomel  every  two  hours,  and  to  have  twenty  leeches  applied 
to  the  head. 

At  9  p.  M.  was  much  the  same  as  in  the  middle  of  the  day.     Was  bled  from  the  arm  to 

3viiJ- 

May  12th,  half-past  8  A.M. — He  complained  still  of  pain  in  the  head,  continued  drowsy; 
pulse  72;  bowels  not  opened,  although  he  had  taken  eight  doses  of  mercury.  Ordered 
Calomel  gr.  v.  every  hour  until  the  bowels  were  relieved.  Leeches  to  be  repeated,  but 
thirty  in  place  of  twenty. 

I  p.  M. — To  continue  treatment. 

II  P.M. — Was  sleeping;  sensible  when  roused,  but  complained  of  pain,  particularly  on 
the  left  side  of  the  head.     Bowels  still  confined;  had  taken  nine  5  gr.  doses  of  Calomel. 
Ordered  an  enema  to  be  administered  immediately,  and  repeated,  if  necessary.     The  Calo- 
mel to  be  omitted  until  the  morning. 

13th.— Sleeps  a  good  deal,  and  he  is  not  easily  roused,  but  quite  sensible,  when  awakened. 
Said,  "  I  have  got  the  headache,  sir,"  and  then  dozed  otf  again ;  pulse  64 ;  bowels  opened 
twice  by  the  enema,  stool  lumpy,  and  dark  brown.  Ordered  Calomel  gr.  v. 

I  P.M. — Rather  more  drowsy;   becoming  forgetful;    leeches  to  be  repeated,  thirty  in 
number. 

7  p.  M. — The  sister  observed  that  he  had  slight  grating  of  the  teeth,  and  almost  immedi- 
ately thrust  his  tongue  from  his  mouth,  and  it  remained  out;  at  the  same  time,  the  right 
arm  was  drawn  up,  and  there  was  rolling  of  the  eyes.     The  sister  thought  he  was  con- 
scious, but  he  could  not  speak.     She  then  sent  for  Mr.  S.,  which  was  at 

8  P.M. — His  countenance  had  become  more  anxious;  he  was  not  so  readily  roused,  and 
answered  less  perfectly  questions  put  to  him,  speaking  in  a  drawling  way ;  pulse  76,  not  so 
full.   A  vein  was  opened  in  the  arm,  but  the  blood,  which  was  very  dark,  flowed  so  slowly, 
that  the  temporal  artery  was  opened.     He  was  raised  from  the  pillow,  and  as  soon  as  little 
more  than  an  ounce  had  flowed,  he  had  a  convulsive  fit;  the  struggle  was  slight,  and  ac- 
companied with  a  slight  moan.     The  artery  was  then  completely  divided,  which  stopped 
the  bleeding,  and  he  was  again  laid  on  the  pillow;  he  almost  immediately  recovered  his 
consciousness;  his  countenance  was  pale,  and  covered  with  cold  sweat;  pulse  56,  irregular. 
In  a  few  minutes  he  seemed  better,  and  said,  in  answer  to  a  question,  that  he  was  easier. 
Ordered  Hydr.  c.  Greta  gr.  ij.  4ta  hor. 

14th  mane primo. — Said  he  was  very  bad;  quite  conscious;  has  had  no  more  convulsions  ; 
complained  of  his  head.  Pulse  72,  soft ;  mouth  rather  tender. 

9  P.  M. — Countenance  more  cheerful ;  head  cooler ;  pulse  80.     Said  he  was  better.     Con- 
tinue treatment. 

II  P.M. — Had  another  convulsive  fit,  which  was  very  short;  foaming  from  the  mouth, 
which  was  drawn  somewhat  to  the  right  side ;  no  scream.     A  few  minutes  before  this,  he 
had  started  up  in  the  bed,  and  would  have  fallen  out,  but  for  the  attendant. 

15th. — Several  fits  of  short  duration  have  occurred  during  the  night. 

Half  past  8. — Countenance  very  heavy  and  dull;  scarcely  any  answer  given  to  questions; 
right  side  of  face  and  arm  partially  paralyzed,  but  can  feel  somewhat  when  pinched ; 
bowels  not  open.  Continue  the  Hydr.  c.  Greta. 

Half-past  7  p.  M. — Has  had  several  fits,  but  not  of  great  length,  nor  severe  ;  countenance 
much  the  same;  answers  slowly,  but  rationally.  Bowels  relieved;  motions  loose  and  green  ; 
pulse  80.  Continue  the  Hydr.  c.  Greta.  Empl.  Lytta?  to  chest.  Acet.  Lyttae  et  Ungt.  Hy- 
drarg.  ad  eundem. 

16th. — Not  so  conscious,  nor  so  well  in  other  respects;  pulse  80.     Continue  treatment. 

17th. — Very  drowsy;  has  frequent  fits,  some  of  longer  duration  than  before;  countenance 
heavy  and  bad;  pulse  140;  cannot  get  him  to  take  food;  is  not  aware  when  it  is  offered 
him. 

18th. — Much  worse;  countenance  continues  anxious;  can  scarcely  answer  any  question; 
pulse  156,  small.  Says  he  wants  his  breakfast;  always  expressing  a  feeling  of  hunger. 
Convulsions  occur  very  frequently. 

19th. — Countenance  more  anxious.  Says  he  is  better,  and  that  the  pain  in  the  head  is 
less ;  has  greater  difficulty  in  speaking,  and  is  certainly  worse.  Continue  Mercury. 


EPILEPSY.  423 

20th.  —  Appears  much  the  same;  says  he  feels  better;  pupils  both  act  to  light;  the  right 
arm  is  paralyzed,  but  not  the  leg;  the  convulsions  continue. 

21st.  —  Convulsions  not  so  frequent  in  occurrence,  but  continue  fora  greater  length  of  time, 
and  are  more  violent;  he  is  not  so  drowsy;  his  countenance  has  improved,  and  he  says  there 
is  less  pain  in  the  head;  pulse  130;  bowels  open.  Continue  treatment. 

22d.  —  The  convulsions  continue  very  violent,  but  occur  less  frequently  even  than  yester- 
day ;  his  countenance  has  much  improved  ;  pupils  act;  pulse  120;  bowels  open.  Says  he 
is  better,  but  complains  of  his  head. 

23d.  —  There  is  little  alteration  as  regards  the  frequency  and  violence  of  the  convulsions. 
He  has  the  power  of  moving  his  arm,  which  was  paralyzed  on  Wednesday  ;  countenance 
continues  good  ;  pulse  120  ;  bowels  open  ;  mouth  beginning  to  get  a  little  tender.  Continue 
treatment. 

24th.  —  Has  had  no  fit  since  last  night  ;  appears  much  relieved  ;  the  pain  in  the  head 
diminished;  countenance  good;  bowels  open;  tongue  cleaning;  pulse  112;  complains  of 
his  gums.  Continue  treatment.  Apply  cold  lotion  to  head. 

25th.  —  Mouth  sore  ;  continues  free  from  fits  ;  complains  less  of  pain  in  the  head  ;  has 
quite  recovered  the  power  of  his  arm;  pulse  108;  bowels  open  ;  appetite  good..  Continue 
the  pills  night  and  morning,  instead  of  every  sixth  hour.  Discontinue  the  application  of  the 
ointment. 

26th.  —  Has  passed  a  good  night;  no  recurrence  of  the  fits;  pain  in  the  head  slight, 
and  confined  to  the  frontal  region  ;  bowels  open;  pulse  108. 

27th.  —  Says  he  is  better;  has  but  little  pain  in  the  head;  tongue  cleaning;  pulse  112; 
bowels  confined.  Ordered  Compd>  Colocynth  pill,  gr.  x.,  to  be  repeated,  if  necessary.  His 
bowels  were  relieved  before  the  Colocynth  was  given,  therefore  no  purgative  required. 

28th.  —  Is  progressing  favorably. 

June  3d.  —  His  gums  are  still  tender,  and  he  is  generally  much  better.  Ordered  Hydr.  c. 
Creta  every  other  night,  instead  of  night  and  morning. 

7th.  —  Is  much  improved  ;  has  no  pain  in  the  head,  or  elsewhere  ;  bowels  regular  ;  tongue 
clean  ;  appetite  good  ;  pulse  90. 

13th.  —  Appears  and  describes  himself  as  feeling  quite  well;  is  rapidly  gaining  strength. 
To  discontinue  the  pills  altogether. 

This  lad  recovered  perfectly. 


Epilepsy.  —  E^a^ij,  from  Ertaappdvu,  "to  invade,  attack,  oppress." 
Of  all  the  various  ills  that  flesh  is  heir  to,  this  is  the  most  distressing  to 
witness.  It  is  no  wonder  that,  in  ancient  times,  the  poor  afflicted  mor- 
tals who  suffered  from  its  influence  were  supposed  to  be  possessed  of  a 
devil.  For  there  is  no  doubt  that  the  Demoniacs  of  Scripture  were 
epileptic  patients. 

As  soon  as  medicine  was  cultivated  as  a  science,  epilepsy  was  treated 
as  a  disease,  and  recorded  by  medical  writers. 

Hippocrates  described  it  under  the  title  of  Morbus  sacer,  and  scouted 
the  idea  of  demoniacal  possession;  and  we  learn  from  the  able  translator 
of  the  works  of  Paulus  ^Egineta,  (Mr.  Adams,)  that  Galen,  Oribasius, 
^Etius,  Aretasus,  Pseudo-Dioscorides,  Alexander  Leo,  and  a  host  of 
others,  including  Rhases,  have  devoted  their  attention  to  the  complaint. 
Dr.  Copland,  whose  learned  article  on  this  subject  ought  to  be  perused 
by  every  member  of  the  profession,  says,  that  by  none  has  it  been  no- 
ticed so  fully  and  accurately  as  by  AretaBus. 

The  outward  signs  of  the  disease,  when  fully  developed,  consist  in 
the  occurrence  of  convulsive  fits,  so  striking,  so  frightful,  and  so  peculiar, 
that,  when  once  seen,  they  can  never  be  mistaken,  either  by  physician 
or  layman,  for  any  other  disease.  I  say  when  fully  developed,  because, 
as  a  general  rule,  the  fits  do  not  attain  their  characteristic  peculiarities 
all  at  once.  The  disease  is  usually  progressive.  In  a  practical  point  of 
view  this  is  most  important.  For  the  time  to  combat  the  disease  with 
most  chance  of  victory,  is,  as  in  apoplexy,  during  the  occurrence  of  the 
premonitory  symptoms,  when  the  disease  is  only  in  embryo. 


424 


HUMAN    BRAIN. 


The  following  is  the  usual  order  of  phenomena  which  constitute  an 
epileptic  Jit.  The  patient  may  be  sitting  at  the  dinner-table,  or  in  a  gig, 
or  anywhere,  in  the  apparent  enjoyment  of  perfect  health,  and  his  face 
will  become  suddenly  flushed,  there  will  be  a  slight  convulsive  action  of 
the  lips,  and  then  a  scream,  more  unearthly  and  horrible  than  any  sound 
uttered  by  living  creature.  The  railway  whistle  makes  some  approach 
to  it.  The  whole  body  now  becomes  convulsed,  and  the  patient,  if  sit- 
ting, is  generally  thrown  from  his  seat  by  the  convulsive  action  of  the 
flexor  muscles,  and  he  falls  forwards.  If  he  is  standing,  he  generally 
falls  in  the  same  way.  Sometimes,  it  is  true,  there  is  a  short,  slight 
warning,  which  enables  him  to  lay  himself  on  the  ground,  and  save  the 
violent  concussion  of  the  face. 

By  the  convulsive  paroxysm,  the  jaws  are  fixed,  and  in  the  sudden- 
ness of  their  closure,  the  tongue  is  usually  severely  bitten.  The  ex- 
pression of  suffering  is  agonizing.  Bloody,  frothy  saliva  issues  from  the 
month.  The  head  is  drawn  down  upon  the  chest,  the  body  curved  for- 
wards, the  thighs  flexed  upon  the  pelvis,  the  hands  violently  clenched. 
The  convulsions  are  usually  more  on  one  side  than  the  other,  and  the 
same  side  always  affected.  The  countenance  is  livid  and  distorted.  In 
the  neck  the  carotid  arteries  may  be  seen  distended,  and  pulsating  vio- 
lently. The  seminal  fluid  is  generally  ejected  during  the  paroxysms  by 
the  violent  convulsive  action  of  the  ejaculator  muscles.  Gradually  the 
muscles  relax,  the  eyes  open  bloodshot,  and  are  turned  upwards  with 
the  ghastly  expression  of  death.  The  breathing  is  slow,  gasping  and 
stertorous,  and  the  poor  sufferer  presents  all  the  appearance  of  one  about 
to  quit  this  earthly  scene.  In  a  few  minutes  more  the  countenance  be- 
comes natural,  and  the  breathing  gradually  less  stertorous,  and  now,  if 
he  is  undisturbed,  he  will  fall  into  a  deep  and  tranquil  sleep,  from  which 
he  wakes  in  about  half  an  hour,  or  an  hour,  wholly  unconscious,  until 
some  minor  circumstance  acquaints  him  with  the  fact  that  he  has  passed 
through  this  fearful  ordeal. 

The  consequences  of  the  severer  paroxysms  vary  very  much.  In 
some  cases,  the  patient  opens  his  eyes  a  few  minutes  after  the  attack, 
and  looks  about  him  as  if  nothing  had  happened,  but  generally  there  is 
complete  coma.  If  the  fits  come  very  close  together,  and  in  any  number, 
the  coma  will  last  some  time — for  days,  and  even  a  week. 

Sometimes  it  is  succeeded  by  complete  mania.  I  was  consulted,  a 
few  days  ago,  by  a  gentleman,  who  told  me  he  was  always  raving  mad 
for  a  few  days  after  a  series  of  fits.  The  effect  of  the  fits  depends  a 
good  deal,  also,  on  whether  the  patient  is  kept  quiet  or  not.  If  he  is 
disturbed  or  annoyed  by  seeing  strange  faces  around  him,  he  is  generally 
much  worse.  On  one  occasion  I  saw  a  gentleman  who  usually  had 
only  five  or  six  fits  at  a  time,  and  these  spread  over  a  period  of  a  week, 
with  intervals  of  six  weeks  or  a  fortnight ;  but  on  this  occasion  he  had 
twenty-four  in  forty-eight  hours,  occurring  regularly  every  two  hours, 
almost  to  a  minute.  The  unusual  number  appeared  to  have  been  pro- 
duced by  mental  excitement,  for  after  the  first  fit  he  wanted  to  get  up, 
and  leave  the  house,  which  was  new  to  him,  and  the  servants  prevented 
him;  this  rendered  him  very  violent,  and  as  he  was  a  strong,  powerful 
man,  a  great  deal  of  force  was  used  to  restrain  him.  After  this  long 


EPILEPSY.  425 

series  of  attacks,  he  was  insensible  for  four  days,  and  did  not  entirely 
recover  his  intellect  for  more  than  a  fortnight. 

Such,  then,  are  the  general  features  of  a  true  and  complete  epileptic 
paroxysm,  or  fit.  The  disease  does  not  always  exhibit  itself  in  pre- 
cisely this  form  ;  there  are  many  modifications  of  it,  particularly  in  its 
commencement.  It  is  very  necessary  to  be  aware  of  these  varieties, 
especially  as  their  serious  nature  is  sometimes  overlooked,  until  a  true 
epileptic  fit  occurs,  which  draws  a  veil  from  the  disease,  painfully  ex- 
posing its  hideous  form  to  the  horror-stricken  friends  and  astonished 
medical  adviser. 

The  milder  attacks,  or  half-attacks,  as  many  patients  call  them,  also 
vary  in  their  intensity.  Sometimes  there  is  a  momentary  unconscious- 
ness :  if  the  patient  is  walking,  he  will  stop  suddenly,  and  gaze  for  a 
few  seconds  quite  vacantly,  or  he  will  turn  round  and  look  on  the  ground, 
as  if  he  were  looking  for  something  that  he  had  lost.  See  Case  79. 

Patients  are  generally  aware  of  having  had  these  attacks,  and  they 
will  tell  you  how  many  they  have  had  in  the  day. 

These  half-attacks  are  sometimes  more  severe — the  petit  mal,  as  it 
is  called  by  the  French.  There  may  be  a  slight  convulsive  movement 
of  the  face  or  lips,  and  the  state  of  unconsciousness  last  longer. 

In  one  case,  they  used  always  to  prove  the  finale  of  the  series  of  fits, 
and  until  the  half-attack  came,  the  patient  and  his  friends  felt  insecure 
as  to  the  occurrence  of  more  fits. 

It  is  curious  that  sometimes  these  half-attacks  derange  the  intellect 
more  than  the  complete  attack.  It  was  decidedly  so  in  the  last  case 
referred  to. 

Foville  observed  that  the  petit  mal  was  attended  with  more  disturb- 
ance of  the  intellect  than  the  complete  attacks. 

Warnings. — These  vary  considerably,  both  as  regards  the  disease 
generally,  and  individuals  in  particular.  Some  patients  that  I  know  have 
a  warning  at  night,  and  not  in  the  day.  Others  say  that  they  used  to 
have  a  warning  when  the  disease  first  came  on,  but  that  they  do  Jiot  now ; 
some  have  headaches,  and  feel  fullness  of  the  head;  others  experience  a 
most  disagreeable  odor  for  a  day  or  two  ;  others,  again,  are  particularly 
well,  cheerful,  and  clear-headed.  One  boy  is  always  excessively  mis- 
chievous and  high-spirited  just  previous  to  an  attack,  and  his  thumbs 
are  drawn  into  the  palm  of  his  hand,  as  in  children  affected  with  crow- 
ing convulsions.  This-turning  in  of  the  thumbs  is  a  very  common  sign 
of  the  approach  of  the  attack.  Some  patients  are  always  found  lying 
on  their  tace  a  night  or  two  previous  to  an  attack.  In  many  cases  there 
is  sufficient  warning  to  enable  the  patient  to  lie  down,  if  walking  in  the 
road,  on  a  bank,  out  of  danger,  and  place  a  handkerchief  in  the  mouth, 
to  prevent  the  tongue  being  bitten.  Sometimes  patients  will  attempt  to 
speak,  to  call  the  attention  of  a  friend,  but  they  can  seldom  articulate 
distinctly.  One  patient  has  always  convulsive  catchings  or  twitchings 
in  the  right  leg  for  a  night  or  two  previous  to  the  fits.  I  have  others  who 
always  have  a  violent  pain  in  the  stomach  previous  to  an  attack.  An- 
other, who  says  she  always  knows  when  an  attack  is  coming  on  by  every- 
thing looking  different;  she  cannot  define  the  appearance,  though  she 
says  she  has  often  attempted.  One  gentleman  I  knew  had  sufficient 


426  HUMAN   BRAIN. 

warning,  which  was  a  singing  in  the  ears,  to  enable  him  to  get  off  his 
horse.  On  one  occasion,  he  did  so  in  Shoreditch,  and  reached  a  shop 
before  he  fell.  I  have  a  young  lady  under  ray  care,  in  whom  the  fit  has 
more  than  once  been  averted  by  pinching  the  nose,  and  sometimes  she 
has  sufficient  warning  to  cry  out,  "My  nose,  ray  nose." 

The  most  curious  warning  is  the  aura  epileptica ;  this  term  is  applied 
to  designate  a  sensation  which  originates  in  one  of  the  extremities,  and 
passes  upwards,  in  the  course  of  a  nerve,  to  the  head.  It  precedes  the 
fit,  and  patients  who  have  experienced  it  say,  that  they  feel  it  distinctly 
until  it  reaches  the  head,  and  then  they  lose  all  consciousness.  They 
sometimes  describe  it  as  a  cold,  sometimes  as  a  warm,  feeling,  but 
always  as  a  creeping  sensation  like  "  pins  and  needles."  It  is  not  com- 
mon ;  out  of  between  forty  and  fifty  cases  of  epilepsy  that  I  have  seen, 
I  have  only  met  with  it  once. 

Sir  Astley  Cooper  used  to  relate,  in  his  lectures,  a  curious  instance  in 
which  he  cured  a  case  of  epilepsy  by  the  removal  of  a  portion  of  the  ra- 
dial nerve.  He  said,  u  A  man  was  sent  to  me,  by  a  surgeon  of  Wat- 
ford, having  this  disease;  he  would  occasionally  be  seized  by  a  severe 
pain  in  the  thumb,  which  gradually  extended  up  the  arm,  in  the  course 
of  the  radial  and  brachial  nerves,  through  the  axilla  to  the  neck  ;  his 
head  would  then  become  twisted,  and  in  a  moment  he  would  drop  on 
the  floor  in  a  fit ;  shortly  afterwards  he  would  get  up,  and  appear  as  well 
as  ever.  I  cut  down  upon  the  radial  nerve  by  the  side  of  the  flexor 
carpi  radialis  longus,  exposed  about  an  inch,  and  removed  five-eighths 
of  it.  After  this  the  pain  entirely  left  him,  and  he  returned  to  Watford, 
where  he  remained  completely  cured." 

Sauvages  is  of  opinion,  that  the  sensation  has  its  origin  in  the  brain, 
though  it  is  referred  to  the  limb,  just  as  a  man  who  has  lost  his  limb 
still  thinks  he  feels  his  toes. 

There  is  no  period  of  life  at  which  these  fits  have  not  been  known  to 
occur ;  they  are  not  frequent  in  infancy.,  or  in  extreme  old  age  ;  but  I 
once  knew  an  old  gentleman  who  was  attacked  at  the  age  of  eighty,  and, 
recovering  from  them,  lived  to  above  ninety,  in  good  health,  and  in  per- 
fect possession  of  his  faculties. 

The  convulsions  which  attend  dentition  in  infancy  have  been  classed 
by  some  authors  with  epilepsy  ;  but  I  think  it  very  doubtful  whether 
they  depend"  on  the  same  pathological  condition ;  and  at  any  rate  a 
medical  man  who  thus  designated  such  fits  would  give  a  great  deal  of 
unnecessary  pain  in  a  family.  But  whatever  the  immediate  cause  of 
the  convulsions  may  be,  they  depend  on  a  very  different  state  of  health 
generally.  They  require  a  very  different  line  of  treatment.  The  cause 
is  one  which  is  acting  without  intermission.  It  is  more  decidedly  in- 
flammatory, and  the  antiphlogistic  measures  which  will  permanently  re- 
move the  convulsions  of  infancy,  would,  in  true  epilepsy,  render  the 
patient  more  liable  to  a  recurrence. 

Georget*  considers  the  disease  more  frequent  among  women  than 
among  men  ;  but  this  does  not  accord  with  my  own  experience. 

Many  of  the  higher  animals  are  subject  to  epilepsy ;  for  instance,  the 

*  Dict.de  Medecine,  21  vols.,  tome  viii.  1823,  p.  207. 


EPILEPSY. 

dog,  cow,  horse  and  pig.     The  fits  that  puppies  are  subject  to  are  true 
epileptic  fits. 

Georget,*  though  he  does  not  deny  the  possibility  of  sympathetic  epi- 
lepsy, says  he  has  never  seen  such  a  case;  he  avows  frankly  that  he 
knows  nothing  of  the  nature  of  epilepsy. 

Post-mortem  examinations  have  failed  to  show  that  epilepsy  is  depend- 
ent on  any  single  morbid  condition  of  either  the  membranes  or  the  brain. 

In  most  instances,  where  the  disease  has  existed  some  time,  some 
morbid  alterations  have  been  discovered  after  death,  which  may  be  di- 
vided into  two  classes — those  which  would  act  as  irritants  to  the  brain, 
such  as  osseous  deposits  on  the  dura  mater,  and  those  which  there  is 
more  reason  to  believe  have  been  occasioned  by  the  paroxysms,  than  that 
they  are  the  cause  of  them,  such  as  thickening  of  the  membranes,  &c. 

Esquirol  says,f  "  Of  all  these  researches,  particularly  of  those  of 
Bonet,  Morgagni,  Baillie,  Greding,  Meckel,  Sprengel,  what  are  we  to 
consider?  Nothing.  Wepfer  and  Lorry  have  drawn  this  sad  conclu- 
sion. Let  us  avow  frankly  that  pathological  anatomy  has  at  present 
shed  but  little  light  on  the  immediate  seat  of  epilepsy.  However,  we 
must  not  be  discouraged ;  nature  will  not  always  be  so  rebellious  to  the 
efforts  of  her  investigators." 

In  many  cases  bony  deposits  have  been  found  on  the  dura  mater,  and 
in  some  instances  even  a  spiculum  of  bone  has  been  found  projecting 
from  the  internal  table  of  the  skull.  But  such  morbid  growths  cannot 
be  considered  the  proximate  cause,  as  these  are  always  there,  whereas 
the  fits  come  in  paroxysms,  and  leave  the  patient  in  the  interval  quite 
well. 

I  quite  agree  with  Dr.  Watson  when  he  says,  "  Dr.  Marshall  Hall's 
doctrine,  that  all  convulsive  diseases  of  the  spinal  marrow  cannot  be 
properly  applied  to  this  convulsive  disease  of  epilepsy."  It  is  very  clear 
that  the  brain  is  always  more  or  less  affected  in  epilepsy  ;  and  the  milder 
forms,  where  there  is  interruption  to  the  mental  operations,  but  without 
any  convulsion,  affords  a  strong  argument  in  favor  of  this  opinion.  All 
that  Dr.  Hall  has  written  is  worthy  of  attention ;  but  the  more  I  have 
seen  of  epilepsy,  the  more  I  am  convinced  that  the  brain,  and  not  the 
spinal  cord,  is  primarily  affected. 

Dr.  Marshall  Hall  divides  epilepsy  into  two  forms,]:  "  Centric  con- 
vulsions, or  epilepsy,"  and  "  Centripetal  epilepsy."  Both  forms  he 
considers  true  spinal,  not  cerebral,  diseases;  but  I  will  quote  his  exact 
words,  that  I  may  not  misinterpret  his  meaning,  and  thus  unintention- 
ally do  injustice  to  this  able  physiologist. 

"  Jlny  disease  within  the  cranium  or  spine,  whether  effusion,  tumor, 
exostosis,  &c.,  may  induce  convulsions  or  epilepsy. 

"  Fright,  or  other  sudden  mental  emotion,  has  induced  convulsion, 
and  this  convulsion  has  been  repeated,  affording  one  of  the  most  de- 
plorable cases  of  epilepsy.  I  have  already  suggested,  indeed,  that  all 
convulsive  diseases  are  affections  of  the  true  spinal  marrow  (I  refer  my 
readers  to  previous  observations). 

*  P.  214.  '  -J-  Des  Maladies  du  Cerveau,  tome  i.  p.  313,  1838. 

J  Page  319,  op.  cit 


428  HUMAN   BRAIN. 

"  The  cerebrum  is  obviously  the  seat  of  the  mind  ;  it  is  neither  sen- 
tient itself,  nor  the  originator  of  motions  in  itself.  The  true  spinal 
marrow,  on  the  contrary,  is  the  term  of  certain  excitements  and  the  com- 
biner of  certain  motions — the  centre,  in  a  word,  of  a  peculiar  series  of 
excito-motory  phenomena,  physiological  and  pathological.  Unlike  the 
cerebrum,  it  induces,  if  stimulated,  convulsive  movements  in  the  organs 
appropriated  to  ingestion  and  egestion,  and  in  the  limbs. 

"  Diseases  within  the  cranium,  by  irritating  excitor  nerves,  or  the 
medulla  oblongata,  induce  convulsions  or  epilepsy,  too  frequently,  alas, 
of  an  incurable  kind.  Disease  within  the  spinal  canal  may  prove  the 
source  of  convulsion  or  epilepsy  still  more  immediately.  This  form  of 
epilepsy  is,  also,  for  the  most  part,  incurable.  These  cases  are,  for  ob- 
vious reasons,  frequently  met  with  in  hospitals,  asylums,  and  work- 
houses. Hence  the  idea  that  epilepsy  is  not  to  be  subdued  by  medi- 
cine, prevalent  amongst  those  who  draw  their  conclusions  from  obser- 
vations made  in  these  establishments.'"1 

Epilepsy  induced  by  external  causes,  not  internal  disease,  he  denomi- 
nates Centripetal  epilepsy. 

u  This  form  of  epilepsy  takes  its  origin  in  the  excitor  nerves  of  the 
true  spinal  system,  involving  the  axis  of  this  system  and  its  motor  nerves 
in  their  turn  ;  functionally,  not  organically.  It  is  for  this  reason  that  I 
have  denominated  this  form  of  epilepsy  centripetal.  This  form  of  epi- 
lepsy is  to  be  viewed  as  curable,  however  difficult  of  cure.  By  avoiding 
the  exciting  causes,  its  attacks  are  avoided  ;  the  susceptibility  to  returns 
subsides;  these  returns  become  less  frequent  and  less  severe,  and,  at 
length,  frequently  cease  altogether.  Everything  depends  upon  rigid 
rules  proposed  by  the  physician,  and  most  strictly  and  perseveringly  ob- 
served by  the  patient. 

"  In  describing  the  causes,  symptoms  and  treatment  of  centripetal 
epilepsy,  I  must  refer  to  all  that  I  have  said  respecting  the  anatomy  and 
physiology  of  the  true  spinal  system.  Every  part  of  this  system  is  dis- 
tinctly but  exclusively  involved  in  the  circumstances  of  the  disease  ;  if 
the  encephalon  suffers,  it  is  only  as  an  effect  of  the  convulsive  attacks."! 

He  then  proceeds  to  speak  of  the  causes,  detailing,  1,  "the  presence 
of  indigestible  food  in  the  stomach;  2,  the  presence  of  morbid  matters 
in  the  intestines;  3,  uterine  irritation.  The  first  of  these  acts  through 
the  medium  of  the  pneumogastric,  the  second  and  third  through  the 
true  spinal  system." 

The  following  facts  illustrate  many  points  in  the  history  of  this  curious 
disease,  which  are  of  importance  and  interest  to  the  practitioner.  The 
mother  of  the  patient  was  a  particularly  intelligent  woman  for  her  sta- 
tion in  life,  and  always  gave  me  a  very  clear  account  of  her  daughter's 
illness.  She  was  a  pale,  delicate  looking  girl,  intelligent,  nervous,  and 
excitable  ;  has  suffered  from  epilepsy  for  some  years.  She  was  a  seven- 
months  child,  born  in  1829,  very  small  and  feeble  ;  she  was  unable  to 
walk  by  herself  till  she  was  two  years  old,  though  at  that  time  her  arti- 
culation was  perfectly  distinct,  and  she  had  abundant  power  of  express- 
ing herself.  Her  excitability  was  so  great,  that  any  over-amusement  or 

.Mi!  ,«l  * 
*   Page  319.  t  P.  322,  op.  cit 


EPILEPSY.  429 

emotion  produced  sleeplessness.  This,  after  the  first  difficulties  were 
overcome,  was  the  great  enemy  the  parents  had  to  contend  with.  At 
the  age  of  sixteen  months  something  like  a  dizziness,  quite  momentary, 
appeared.  The  eye  became  fixed,  with  a  quick  vibration  of  the  head, 
and  a  tendency  to  fall  forward,  so  that  at  that  time  if  she  could  have 
been  unsupported  she  must  have  overbalanced  herself.  This,  which 
was  for  some  time  only  apparent  to  the  mother,  increased  in  degree  and 
duration  so  much  that,  at  the  age  of  three  years,  when  she  was  a  very 
lively,  talkative  child,  it  became  evident  to  all,  for  in  the  midst  of  her 
prattle  she  would  frequently  stop  short,  the  head  would  nod  forward 
several  times,  and  sometimes  she  would  fall.  The  lapse  in  conscious- 
ness was  so  complete  that,  though  she  always  recovered  herself  in  a 
minute  with  a  deep  sigh,  she  never  regained  the  thread  of  her  story,  but 
passed  to  something  else,  having  forgotten  it.  These  little  effects  were 
considerably  augmented  by  emotion,  fatigue,  or  excitement;  and  this 
appeared  to  be  the  first  stage  of  the  complaint. 

The  second  stage  arose  when  she  was  five  years  old.  The  nodding 
had  much  increased  lately,  and  now  came  on  what  the  parents  called  the 
seizures,  which  were  an  odd  state  of  semi-consciousness,  with  a  great 
deal  of  spasmodic  motion  of  the  body,  inability  to  direct  the  eyes  to  any 
particular  object,  or  even  to  fix  both  on  the  same  thing;  a  rambling  con- 
versation, with  a  hesitating,  tremulous  voice,  accompanied  with  many 
ocular  delusions.  This  state,  w7hich  came  on  every  few7  days  on  first 
waking,  generally  lasted  about  half  an  hour,  though  sometimes  through 
the  day,  and  often  ended  without  any  fit  or  crisis.  In  the  second  year 
it  assumed  a  periodical  character,  returning  on  the  third,  and  then  on 
the  fifth  morning.  At  these  times  water  was  passed  unconsciously,  and 
the  bowels  generally  moved,  before  she  could  give  warning.  No  notice 
was  ever  taken  to  her  of  these  attacks,  and  great  attention  was  paid  to 
remove  from  her  objects  of  excitement,  and  to  keep  her  brain  in  repose, 
— and  so  we  come  to  the  third  stage. 

At  the  age  of  seven,  the  nurserymaid,  who  was  dressing  her,  sud- 
denly fell  back  in  a  strong  epileptic  fit,  which  it  was  impossible  to  con- 
ceal from  the  child,  who  appeared  deeply  affected  by  it,  and  on  the 
following  morning  (which  was  the  day  for  the  seizure)  having  continued 
the  usual  time  in  her  semi-conscious  state,  instead  of  recovering  from  it, 
she  stretched  herself,  and  went  off  into  a  fit  of  the  ordinary  epileptic 
character.  These  fits  have  now  continued  for  nearly  nine  years,  being 
always  ushered  in  by  the  semi-conscious  spasmodic  state  on  first  waking. 
Most  of  the  usual  remedies  employed  in  cases  of  epilepsy  have  been 
tried,  such  as  Valerian,  Copper,  Indigo,  Musk,  and  Oil  of  Turpentine, 
all  with  some  good  effect  for  a  time  ;  Indigo  and  Oil  of  Turpentine  with 
great  success,  particularly  the  latter,  till  she  became  quite  accustomed 
to  it,  when  its  efficacy  gradually  wore  away.  The  symptoms  which  in- 
dicate the  fit  generally  appear  on  the  preceding  day,  consisting  chiefly 
of  a  rapid  quivering  of  the  eyelids,  nodding  of  the  head,  with  lapse  in 
conversation,  sometimes  pain  in  the  forehead  ;  but  if  this  last  increases 
to  a  real  headache,  so  as  to  end  in  sleep  or  in  vomiting,  the  next  day's 
fit  is  generally  averted  for  three  or  four  days  at  least,  sometimes  for  a 
longer  period  ;  she  has,  in  consequence,  frequently  had  given  her  an 


430  HUMAN    BRAIN. 

emetic  under  these  threatening  signs,  and  with  success.  Four  or  five 
weeks  may  perhaps  be  considered  as  a  fair  average  duration  for  the  in- 
terval between  the  fits  ;  towards  the  latter  part  of  that  time  the  irritation 
has  been  very  visibly  accumulating,  though  often  disappointed,  as  it  were, 
by  the  emetic  or  blister  behind  the  ear,  till  it  has  become  uncontrollable, 
and  has  ended  in  a  fit.  The  fit  leaves  no  cloud  on  the  mind,  but  a  great 
languor  of  body  for  one  or  two  days,  after  which  all  nervous  suscepti- 
bility seems^uite  gone.  For  a  week,  at  least,  all  vibration  of  the  eye- 
lids is  quite  suspended,  and  the  mind  appears  to  be  perfectly  calm  and 
free  from  excitation.  On  eight  different  occasions  she  has  lain  in  con- 
vulsions for  three  hours.  These  attacks  have  not  begun  like  the  common 
fit,  which  is  with  a  scream,  and  struggle  to  turn  on  the  face  ;  they  have 
generally  set  in  with  strong  movement  in  one  arm,  which  is  lifted  above 
the  head  ;  they  have  been  preceded  by  the  usual  semi-conscious  state, 
and,  during  the  last  half  hour  before  the  convulsion  began,  by  an  appa- 
rent insensibility,  when  the  saliva  has  bubbled  from  the  mouth,  and  the 
hearing  has  seemed  quite  gone.  During  the  whole  time  that  these  con- 
vulsions have  lasted,  the  heart  has  beat  violently,  the  face  has  been  suf- 
fused with  red,  and  the  lips  purple ;  during  the  three  hours  the  convulsive 
agitation  has  been  incessant,  growing  fainter,  till  the  poor  child  has  at 
last  sunk  exhausted  to  sleep,  but  not  till  the  struggle  for  breath  and  the 
apparent  thread  of  suffocation  were  frightful  to  see.  She  has  had  no 
such  severe  attack  for  four  years. 

On  eight  other  occasions  she  has  lain  in  the  semi-conscious  state 
through  two  successive  days;  sometimes  the  fit  has  closed  it,  and  some- 
times natural  sleep.  It  is  also  a  long  time  since  she  has  had  an  affection 
of  this  kind. 

The  pulse  always  increases  steadily  in  frequency  from  its  ordinary 
rate,  about  70  in  the  minute,  up  to  90  or  a  100,  previous  to  the  attack 
occurring.  I  ordered  the  digitalis  in  this  case  with  apparently  some 
benefit,  but  I  have  since  lost  sight  of  the  case. 

In  the  treatment  of  all  disease,  we  ought  to  have  some  distinct  idea  of 
the  pathological  condition  on  which  it  depends.  In  many  diseases  it  is 
extremely  difficult  to  come  to  any  satisfactory  conclusion,  but  still  it  is 
our  duty  to  attempt  it.  Before  we  consider  the  treatment  of  this  disease, 
I  will  theorize  a  little  on  its  pathology.  In  detailing  the  following 
theory,  I  am  too  well  aware  that  it  does  not  deserve  a  higher  title  than 
a  theory;  I  do  not  pretend  that  it  has  originated  with  me,  though  I  know 
not  on  whom  to  father  it. 

The  first  morbid  action  is  a  sudden  determination  of  blood  to  the 
brain,  which  expends  itself,  in  the  secretion  of  that  nervous  power  which, 
in  a  state  of  health,  is  employed  by  the  brain  to  convey  volition  to  the 
muscles,  and  which  power  is,  I  have  no  doubt,  identical  with  electricity. 
This  excessive  secretion  is  carried  off  by  the  motor  nerves,  like  a  dis- 
charge from  an  electric  battery,  and.  from  its  quantity  and  excess,  pro- 
duces excessive  action  of  the  muscles.  It  is  another  illustration  of  a 
law  that  vre  had  occasion  to  decide  upon  already,  namely,  that  the  first 
effect  of  arterial  excitement  in  every  secreting  organ  is  to  excite  to  an 
unnatural  degree  the  natural  function  of  the  organ.  We  know  that 
mental  emotion  will  cause  a  sudden  determination  of  blood  to  other 


EPILEPSY.  431 

organs,  which,  according  to  the  nature  of  the  part,  will  be  followed  or 
not  by  secretion. 

Blushing  and  erection  of  the  penis  are  instances  of  sudden  determina- 
tion of  blood  to  a  particular  part.  And  the  lachrymal  glands,  salivary 
glands,  testicles,  prostate  gland,  gastric  glands,  and  even  the  kidneys, 
often  pour  fourth  their  secretions  so  abundantly  and  so  suddenly  that  the 
formative  fluid,  the  blood,  must  have  circulated  through  their  capillaries 
in  greater  quantity  and  with  greater  rapidity  than  when  the  glands  were 
at  rest,  and  their  secretions  suspended.  I  think  that  the  periodic  attacks 
of  mania,  with  which  many  of  the  insane  are  afflicted,  may  be  regarded 
in  this  light. 

Since  writing  the  above,  I  have  met  with  the  following  observations 
of  that  excellent  physician,  Dr.  Alison,  which  I  am  delighted  to  quote  in 
support  of  my  views,  though  it  may  deprive  me  of  any  credit  of  originality.* 

11  There  are  hardly  any  chronic  local  diseases  in  which  local  determina- 
tions and  congestions  of  blood  do  not  occur;  and  we  are  not  sufficiently 
informed  of  the  cases  in  which  such  irregularity  in  the  distribution  of  the 
blood  may  be  regarded  as  the  primary  or  fundamental  morbid  change. 
Probably  these  cases  are  in  reality  few,  but  it  is  important  briefly  to 
enumerate  the  principal  diseased  states  in  which  morbid  determinations 
of  blood  certainly  occur,  and  in  a  great  measure  determine  their  extent 
and  intensity,  and  injurious  results.  Thus,  very  various  derangements 
of  the  functions  of  the  nervous  system,  headaches,  giddiness,  transient 
imperfections  of  sense,  or  «of  memory,  fits  of  epilepsy,  of  hysteria,  or 
other  spasms,  even  of  mania,  in  those  predisposed  to  these  diseases. 
Some  cases  of  transient  paralytic  affections,  and  many  of  apoplexy,  ap- 
pear to  result  from  simply  increased  afflux  of  blood  to  the  brain,  without 
rupture  of  its  vessels,  disorganization  of  its  texture,  or  even  increased 
effusion  of  its  serous  fluid." 

The  vessels,  which  are  especially  the  seat  of  this  morbid  action,  I 
suspect,  are  those  of  the  choroid  plexus,  and  one  of  the  layers  of  the 
cortical  substance.  The  choroid  plexus  is  frequently  found  hypertro- 
phied  in  the  brain  of  epileptics,  assuming  an  almost  fleshy  appearance. 
This  hypertrophy  would,  very  probably,  be  the  effect  of  repeated  action. 
It  is  also  the  seat  of  small  tumors,  generally  like  hydatids. 

The  expression  "  determination  of  blood  to  the  head"  is  often  made 
use  of,  but  without  any  explanation  of  the  manner  in  which  this  takes 
place.  I  doubt  whether  the  profession  generally  have  any  distinct  idea 
as  to  the  exact  condition  of  the  vascular  system  which  produces  it.  I 
would  venture  to  offer  the  following  theory,  the  first  idea  of  which  I 
certainly  derived  many  years  ago  from  that  most  truly  philosophical  work, 
the  Elements  of  Physics,  of  Dr.  Arnott.  It  applies  not  merely  to  the 
head,  but  everywhere  else.  The  middle  or  muscular  coat  of  the  arteries 
in  a  state  of  health,  contracts  with  each  systole  of  the  ventricles  just 
sufficiently  to  give  a  solidity  to  the  wall  of  the  pipe,  so  that  the  force  of 
the  contraction  is  not  lost  on  a  yielding  surface.  A  much  greater  force 
is  required  to  drive  water  through  a  leather  hose  than  through  a  leaden 
tube.  The  middle  coat  contracts  just  sufficient  to  assimilate  the  artery 

•  Alison's  Pathol.,  p.  554,  op.  cit 


432  HUMAN   BRAIN. 

physically  and  temporally  to  the  leaden  tube.  Arteries  with  permanently 
rigid  walls,  like  leaden  tubes,  would  have  interfered  by  their  rigidity 
with  the  motions  of  the  limbs;  and  hence  this  beautiful  contrivance. 
When  this  middle  coat  does  not  contract,  or  only  contracts  imperfectly, 
then  the  force  of  the  heart  dilates  the  tubes,  and  produces  congestion. 

I  believe,  then,  that  determination  of  blood  to  the  head  arises  simply 
from  deficient  contraction  of  the  muscular  coat  of  the  capillaries  of  the 
brain,  preceded  by  excitement  of  the  heart's  action. 

The  throbbing  of  the  carotid  arteries  may  be  considered  as  corrobora- 
tive evidence  in  favor  of  this  opinion.  The  throbbing  cannot  arise  from 
action  of  the  vessel ;  it  is  the  action  of  the  heart  felt  strongly,  and  seen 
distinctly,  because  the  tube  yields  to  the  impulse  of  the  left  ventricle, 
instead  of  resisting  it,  like  a  solid  leaden  pipe.  If  the  throbbing  arose 
from  the  action  of  the  artery,  it  would  not  be  synchronous  with  the  heart, 
which  it  is.  It  is  the  same  yielding  of  the  coat  of  the  capillaries  in  an 
inflamed  limb  which  gives  rise  to  the  throbbing  sensation,  which  all  of 
us  have  felt  in  some  small  spot  or  another. 

I  think  it  not  at  all  improbable  that  the  reason  why  these  capillaries 
of  the  brain  thus  suddenly  and  unnaturally  neglect  to  perform  their  duty, 
is  some  defective  innervation  from  the  sympathetic  nerves,  whose  office 
I  hold  to  be  the  regulation  of  the  coat  of  the  arteries,  so  as  to  produce 
secretions,  &c.  ;  and  so  for,  I  can  see  much  probability  in  the  opinion 
of  the  Wenzels,  that  the  pituitary  gland  is  in  fault  in  epilepsy — believ- 
ing, as  I  do,  with  Dr.  Copland,  that  this  gland  is  the  cerebral  ganglion 
of  this  nervous  system. 

The  following  are  Dr.  Copland's  words  in  reference  to  apoplexy  :* 
"  Upon  tracing  the  relation  subsisting  between  the  various  causes  of  the 
disease,  the  symptoms,  and  the  appearances  on  dissection — upon  remark- 
ing as  far  as  my  own  observation  has  gone,  the  frequency  of  change  in 
the  pineal  and  pituitary  glands  of  apoplectic  patients — I  am  induced  to 
infer  that  functional  lesion,  or  organic  change,  often  commences  in  that 
portion  of  the  ganglial  system  which  supplies  the  encephalon  and  its 
blood-vessels ;  and  that,  owing  to  exhaustion  of  its  influence,  the  capil- 
laries lose  their  vital  tone,  have  their  circulating  functions  impaired, 
become  more  or  less  dilated,  and  are  disposed  to  rupture." 

The  invaluable  researches  of  Dr.  Burrows  have  shown  that  the  ves- 
sels of  the  brain  may  contain^a  larger  quantity  of  blood  at  one  time  than 
another,  just  as  the  vessels  in  any  other  part  of  the  body  may  be  so  af- 
fected. 

Dr.  Bright  says,f  "  There  is  no  organ  of  the  body  liable  to  such  rapid, 
violent,  or  frequent  changes  in  the  state  of  its  circulation,  as  the  brain  ; 
and  while  the  excitement  to  which  other  organs  are  exposed  is  in  some 
degree  limited,  those  which  act  on  the  brain  seem  to  be  almost  unlimit- 
ed, augmenting  with  every  increase  of  luxury  and  civilization."  "  It 
is  impossible  for  us  not  to  feel  admiration  at  the  wonderful  power  of 
resistance  by  which  the  brain  is  daily  preserved  from  disorganization, 
when  we  consider  the  intensity  of  mental  application  to  which  it  is  ex- 
posed, the  violence  of  internal  strife  by  which  it  is  agitated,  the  heed- 

*  Diet.,  vol.  i.  p.  97.  t  Op.  «t>  p.  653. 


EPILEPSY.  433 

less  stimulation  to  which  its  vessels  are  subjected,  and  the  rapid  vicis- 
situdes of  temperature,  and  the  severe  and  neglected  external  injuries 
to  which  it  is  liable." 

There  are  many  circumstances  attending  organic  disease  of  the  brain, 
which  I  think  can  only  be  accounted  for  on  the  supposition  that  the 
quantity  of  blood  in  the  brain  varies  very  much  at  different  times.  One 
of  the  most  striking  of  these  is  the  remission  of  pain,  and  accession 
being  produced  by  anything  that  would  tend  to  accelerate  the  circu- 
lation. In  the  following  quotation  from  Dr.  Abercrombie,  I  have  put 
in  italics  those  phenomena  which  appear  to  me  to  support  this  view  of 
the  subject.* 

"  The  pain  is  in  some  cases  acute  and  lancinating,  in  others  obtuse  ;  and 
it  is  sometimes  referred  to  a  particular  spot,  as  the  crown  of  the  head 
or  the  occiput.  In  many  cases  it  is  accompanied  by  a  violent  throbbing, 
and  this  also  may  be  general,  or  it  may  be  referred  to  a  particular  part 
of  the  head,  as  the  occiput,  or  one  temple.  In  the  more  violent  parox- 
ysms the  pain  is  intense,  obliging  the  patient  to  remain  for  a  considerable 
time  in  one  position,  the  slightest  motion  aggravating  it  to  perfect  tor- 
ture; but  the  remissions  from  this  severe  suffering  are  often  so  remark- 
able as  to  lead  a  superficial  observer  into  the  belief  that  it  is  merely 
periodical  headache,  or  headache  connected  with  dyspepsia.  This  lat- 
ter supposition  is  also  countenanced  by  the  stomach  being  frequently 
much  disordered,  and  by  the  more  violent  attacks  being  often  accom- 
panied by  vomiting.  The  diagnosis,  indeed,  is  sometimes  difficult, 
but,  by  attention,  it  will  be  found  that  the  duration  and  violence  of  the 
pain  must  lead  to  a  suspicion  that  the  complaint  is  something  more  than 
common  headache,  and  that  though  the  stomach  is  at  times  disordered, 
yet  that  the  headache  is  often  most  severe  when  no  disorder  exists  in 
the  stomach  that  can  account  for  it.  The  patient  generally  cannot  bear 
a  warm  room,  the  noise  of  company,  or  even  the  exertion  of  cheerful  con- 
versation,  without  becoming  distressed  and  his  headache  increased;  and 
the  same  effects  are  produced  by  wine  and  bodily  exertion.  He  seeks  quiet- 
ness, coolness,  and  darkness;  and  in  these  respects  the  disease  differs  re- 
markably from  dyspeptic  headache,  which  is  commonly  dissipated  by  ex- 
ercise and  cheerful  company.  Sometimes  the  paroxysms  are  accompa- 
nied by  vomiting,  and  sometimes  by  violent  throbbing  in  the  head" 

Most  authors  who  have  written  on  epilepsy  agree  in  stating  that  the 
brain  is  in  a  state  of  congestion  during  the  fit. 

Esquirol  says,f  "  Sanguineous  plethora  has  been  admitted  by  all  authors 
as  a  cause  of  essential  epilepsy."  Foville  states  that  the  brain  of  patients 
who  have  died  in  the  fit  is  always  found  congested ;  but  he  attributes  it 
to  the  mode  of  death,  which  he  considers  from  suffocation  ;  and  that  the 
same  appearances  are  found  in  persons  who  have  died  by  hanging;  that 
they  are  not  peculiar  to  epilepsy ;  and  that  they  do  not  explain  the  attack, 
but  only  point  out  the  way  in  which  it  has  been  fatal.  Upon  this  Dr. 
Watson  remarks,!  "  It  is,  I  fancy,  a  very  common  notion,  both  that  such 
congestion  does  take  place,  and  that  it  is  the  cause  of  the  paroxysm." 

*  Abercrombie,  op.  cit.,  p.  317.  f  Op.  cit.,  tome  i.  p.  307,  1838. 

J  Lectures,  2d  edit.,  1845,  vol.  i.  p.  617. 

28 


434  HUMAN    BRAIN. 

Dr.  Watson  does  not  agree  in  this  view,  and  for  the  following  reason  : — 
"  In  the  first  place,  it  is  not  easy  to  conceive  that  the  congestion  could 
so  suddenly  arise  and  subside  again,  as  it  must  sometimes  do,  if  it  be  the 
immediate  determining  cause  of  the  fit,  within  the  space  of  a  single 
minute,  for  example.  In  the  second  place,  the  signs  of  external  con- 
gestion and  plethora,  by  which  signs  we  measure  the  amount  of  the 
internal  or  most  marked,  just  when  the  symptoms  of  the  paroxysm  begin 
to  subside  and  disappear,  so  that  we  cannot  look  on  the  congestion  as  a 
cause  of  the  convulsive  symptoms."  In  answer  to  the  first,  I  would 
suggest  that,  as  it  is  not  owing  to  venous  congestion,  but  to  arterial,  it  is 
quite  possible  that  this  should  subside  suddenly,  supposing  the  blood  to 
be  employed  in  the  arterial  capillaries  in  the  secretion  of  the  power 
(whether  the  electric  fluid  or  not)  which  is  suddenly  discharged  by  the 
nerves  into  the  muscles;  and  in  regard  to  the  second,  I  think  that  the 
congested  state  of  the  venous  system,  after  the  convulsive  explosion  has 
taken  place,  can  only  be  caused  by  the  flow  of  blood  from  the  arterial  or 
secerning  system.  Dr.  Holland  considers  this  condition  of  the  arteries, 
•which  I  believe  to  be  the  immediate  cause  of  determinations  of  blood, 
dependent  on  nervous  influence.  He  says,  "  I  find  among  my  notes 
many  instances  of  partial  change  in  the  arterial  circulation ;  some  in  which 
the  effect  was  manifest  even  in  the  larger  arteries,  leading  to  a  part  under 
this  influence."5  "An  example  has  recently  occurred  to  me  of  slight 
hemiplegia  evidently  connected  with  cerebral  disease,  where  the  beat 
of  the  arteries  on  one  side  of  the  head  was  wholly  different  in  character 
from  that  on  the  other,  as  shown  even  in  the  carotid  itself;  and  similar 
differences  probably  exist  in  many  cases  of  this  nature.  The  strong 
beatings  which  sometimes  occur  in  the  course  of  particular  arteries  are 
well  known  ;  and  though  we  may  hesitate  to  describe  them,  with  Laen- 
nec,  as  neuralgic  spasms  of  the  artery,  yet  it  is  difficult  to  attribute  them 
to  any  other  than  nervous  influence,  of  some  kind,  on  the  coats  of  the 
vessels  so  affected."! 

With  regard  to  the  cause  of  epilepsy,  Dr.  Copland  thus  expresses 
himself  :J — 

"  That  in  the  simple  and  early  disease  it  is  not  dependent  upon  any 
lesion  cognizable  by  our  unassisted  senses,  unless  such  lesion  be  seated 
in  the  medulla  oblongata  or  pituitary  and  pineal  glands — parts  not  yet  suffi- 
ciently examined  in  this  malady,  and  which  may  be  dangerously  affected, 
without  manifesting  any  material  change.  That  the  appearances  found 
in  old  or  complicated  cases  are  to  be  referred  rather  to  the  repeated  de- 
rangements the  circulation  of  the  brain  has  suffered  in  the  paroxysm,  and 
to  the  nature  of  the  associated  disease,  than  to  the  lesions  detected  in 
fatal  cases;  such  lesions,  however,  when  induced  in  the  course  of  other 
disorders,  being  occasionally  exciting  or  concurrent  causes  of  the  epi- 
leptic attacks.  That  general  congestion  of  the  encephalic  vessels  evi- 
dently exists  in  the  second  or  convulsive  stage  of  the  fit ;  but  it  is  not 
so  manifest  that  this  state  is  present  from  the  commencement  of  the 
seizure,  as  cases  have  presented,  at  this  period,  symptoms  of  a  very  op- 
posite condition.  This  congestion  is  only  a  passing  phenomenon,  evi- 

• 

*  Med.  Notes  and  Reflec.,  533.  f  °P-  ciL>  P-  54°-  t  Med-  Dict-»  P-  797- 

' 


EPILEPSY.  435 

dently  caused  by  interruption  to  the  respiratory  actions,  impeded  circu- 
lation through  the  heart,  and  to  the  spasmodic  action  of  the  muscular 
system,  and  is  not  the  cause  of  the  seizure  ;  the  principal  phenomena 
of  the  fit  even  ceasing  at  the  very  moment  when  the  congestion  is  at  its 
height.  The  paroxysms  of  epilepsy  cannot,  therefore,  be  imputed  to  the 
congestion,  which  is  evidently  an  advanced  or  consecutive  phenomenon 
produced  as  now  stated,  but  must  be  referred  to  the  parts  on  which  sen- 
sibility depends,  and  which  actuate  the  respiratory  and  muscular  organs." 

"Congestions  of  blood  do  not  occur;  and  we  are  not  sufficiently  in- 
formed of  the  cases  in  which  such  irregularity  in  the  distribution  of  the 
blood  may  be  regarded  as  the  primary  or  fundamental  morbid  change. 
Probably  these  cases  are  in  reality  few,  but  it  is  important  briefly  to 
enumerate  the  principal  diseased  states  in  which  morbid  determinations 
of  blood  certainly  occur,  and  in  a  great  measure  determine  their  extent 
and  intensity  and  injurious  results.  Thus  very  various  derangements  of 
the  functions  of  the  nervous  system,  headaches,  giddiness,  transient  im- 
perfections of  sense  or  of  memory,  fits  of  epilepsy,  of  hysteria  or  other 
spasms,  even  of  mania,  in  those  predisposed  to  these  diseases,  some 
cases  of  transient  paralytic  affections,  and  many  of  apoplexy,  appear  to 
result  from  simply  increased  afflux  of  blood  to  the  brain,  without  rupture 
of  its  vessels,  disorganization  of  its  texture,  or  even  increased  effusion  of 
its  serous  fluid." 

My  own  observations  do  not  accord  with  Dr.  Copland,  in  so  far  as  I 
have  always  witnessed  a  flushing  of  the  face  previous  to  convulsive 
paroxysm,  previous,  as  I  believe,  to  the  discharge  of  the  electric  fluid 
in  those  epileptics  who  were  full  blooded  and  plethoric.  In  the  very 
feeble  and  asthenic,  I  suppose  that  the  surplus  quantity  of  blood  has  not 
been  sufficient  to  overcharge  the  brain  and  flush  the  cheeks  at  the  same 
moment. 

The  amazing  benefit  which  I  have  seen  derived  from  the  use  of  digi- 
talis, as  described  under  the  head  of  "  Treatment,"  is  strongly  corrobo- 
rative of  this  theory.  This  powerful  medicine  was  most  serviceable 
when  it  kept  the  pulse  down  even  below  the  standard  of  health. 

The  following  case  I  have  selected,  as  most  illustrative  of  this  view 
of  the  subject,  inasmuch  as  our  patient  had  only  two  complete  fits  after 
commencing  the  digitalis,  though  previously  he  had  two  or  three  dur- 
ing one  day  in  each  week.  The  half  attacks  gradually  disappeared  also. 
The  pulse,  which,  previous  to  the  exhibition  of  the  digitalis,  was  quick 
and  very  irritable,  was  kept  down  by  this  medicine  to  54  in  the  minute  ; 
seldom  above  this,  sometimes  below. 

Case  79.— C.  S.  G.,  set.  19.  Fresh  complexion,  healthy  looking,  steady  habits,  neither  ad- 
dicted to  masturbation  nor  venery.  Consulted  me  February  3d.  1845,  for  epilepsy.  About 
June,  1843,  he  had  a  severe  mental  impression  from  reading  "Diary  of  a  Physician" — de- 
pressed. In  Oct.  1843,  he  lost  consciousness  when  playing  at  Loto,  but  without  any  fit:  this 
half  attack  occurred  nearly  every  day  until  he  had  bis  first  fit,  which  happened  on  the  27th 
February,  1844,  between  one  and  five  in  the  afternoon.  He  had  another  on  the  10th  May, 
another  on  .the  llth  November,  one  on  the  9th  December,  and  on  the  20th  January  he  had 
two,  between  one  and  five  in  the  afternoon.  His  father  had  been  dead  some  years  :  two  or 
three  years  previous  to  his  decease  his  powers  of  mind  became  weakened  so  much  as  at 
last  to  incapacitate  him  for  business:  he  had  two  or  three  attacks  of  fainting,  attended  with 
partial  paralysis;  his  last  and  fatal  attack  lasted  only  for  two  or  three  days.  Post-mortem 
showed  a  colorless  state  of  the  brain,  with  softening,  and  a  few  ounces  of  fluid  in  the  ven- 


436  HUMAN    BRAIN. 

tricles :  his  symptoms  during  life  were  attributed  by  his  medical  attendants  to  ramollisse- 
ment. 

February  3d. — The  attacks  have  lately  come  on  more  frequently,  generally  exhibiting  a 
sudden  loss  of  consciousness  and  memory  for  a  short  time,  then  recovering  also  suddenly. 
He  generally  turns  pale,  his  lips  blue,  and  his  hands  sometimes  slightly  convulsed;  some- 
times one,  sometimes  two,  attacks  of  this  kind  in  the  day.  I  ordered  him  to  take  Argent 
Oxyd.  gr.  j.b.  d.  Ext.  Col.  co.  gr.  v.  o.  n. ;  and  on  the  3d  of  March  to  take  it  three  times  a 
day  with  gr.  ij.  of  Ext.  Col.  co. ;  also  Liq.  Potass,  ijifs  Tinct.  lodinei  co.  gj.  Sp.  ^Ether.  Nit. 
^ifs.  Capt.  coch.  min.  ex  aqua.  b.  d. 

March  1st. — Had  a  decided  fit  while  walking  with  his  mother — was  in  a  state  of  uncon- 
sciousness for  several  minutes  previous  to  the  fit.  There  was  no  flushing  of  the  counte- 
nance, no  cry,  countenance  blue  during  the  fit,  but  soon  recovered  its  color,  the  struggle  was 
not  severe,  and  did  not  last  long.  He  remembered  everything  before  it  occurred,  does  not 
believe  it  was  so  severe  as  usual,  slept  for  an  hour  on  his  arrival  at  home. 

April  7th. — Has  been  going  on  much  the  same,  the  attacks  increasing  rather  in  frequency 
than  otherwise.  Ordered — continue  Argent.  Oxyd.  The  attacks  still  increased  rather  in 
frequency,  if  not  in  severity,  till  the  27th  June,  1845,  on  which  day  he  went  to  stay  with 
Mr.  B.  in  the  country.  To  take  Argent.  Oxyd.  gr.  j.  Ext.  Col.  co.  Ext.  Gentian,  co.  gr.  iifs.  ft. 
Pil.  ij.  t.  d.,  and  an  aloetic-  pill  at  bed-time.  The  imperfect  attacks  generally  occur  three  times, 
sometimes  four  or  five  times  a  day. 

August  14th. — Had  a  complete  attack  at  1  P.M. — lasted  a  quarter  of  an  hour,  attended  with 
great  frothing  at  the  mouth,  with  considerable  congestion  of  the  head  and  face,  not  followed 
by  any  coma.  Has  always  three  partial  attacks  in  a  day. 

23d. — Has  had  no  fits  for  four  days;  this  morning  at  10  A.M.  he  had  an  attack,  limbs  rigid 
and  strongly  convulsed — lasted  about  ten  minutes.  Had  another  attack  of  the  same  dura- 
tion at  6  P  M.  soon  after  dinner,  strong  convulsions,  lividity  of  features,  intense  action  of 
carotids.  Was  yesterday  subjected  to  a  little  excitement  from  a  visit  home.  A  leech  was 
applied  to  the  nostrils.  Pil.  Hydrarg.  Ext.  Col.  co. 

August  25th. — Argent.  Oxyd.  Zinci.  Oxyd.  gr.  j.  Ext.  Col.  co.  gr.  iifs.  ft.  Pil.  t.  d.  s.  App. 
Lin.  Tinct.  lodinei.  c.  Liq.  Potassae. 

31st. — Has  had  three  half  attacks  daily,  but  they  are  less  severe;  at  the  present  time  he 
is  rarely  insensible  during  their  continuance,  and  is  conscious  of  their  existence. 

September  5th. — Five  attacks  yesterday,  with  symptoms  of  indigestion. 

1 5th. — Better :  attacks  slighter  and  less  frequent. 

29th. — Heavy  and  low  spirited:  a  leech  has  been  applied  to  the  nostril  occasionally,  and 
with  benefit. 

November  2d. — Still  has  four  attacks  daily,  though  not  so  severe. 

6th. — A  complete  attack  with  convulsions,  but  short.     Two  half  attacks  in  the  evening. 

llth. — Three  half  attacks  daily.     Zinci  Sulph.  gr.  ij.  Conf.  Rosae.  q.  s. 

29th. — He  continues  much  the  same,  general  health  pretty  good,  sometimes  three,  some- 
times even  five,  half  attacks  per  day;  three  every  Sunday.  To-day  he  was  ordered  to  omit 
the  pills  and  commence  taking  Inf.  Digitalis  3J.  every  night. 

Jan.  4th,  1846. — Four  half  attacks  daily,  two  complete  to-day.  These  two  are  the  last  he 
has  bad. 

6th. — Dose  increased  to  gifs. 

9th. — Three  half  attacks,  pulse  84. 

10th.— But  one  half  attack. 

15th. — Has  had  three  per  day  lately,  to-day  but  one,  silent  and  depressed,  pulse  78.  Omit 
for  two  days. 

16th.— No  half  attack. 

19th. — Dose  has  been  reduced  to  ^i. ;  no  attack. 

27th. — Has  had  no  attacks  at  all  since  last  report,  but  has  had  four  half  attacks  to  day. 

28th.— Five;  £x. 

February  1st. — None;  pulse  58.     Has  had  some  sickness,  which  has  gone  off. 

6th. — None. 

7th. — None :  very  sick :  omit  medicine  two  days. 

30th.— Three  half  attacks. 

18th. — None;  has  had  one  daily  for  the  last  few  days. 

27th. — None;  pulse  84.     Irregular.     Dose  ^ifs. 

March  1st. — No  attack,  general  health  excellent. 

6th. — Has  had  one  yesterday  and  to-day. 

24th. — Has  had  some  days  one  attack,  on  others  none  during  the  day.  Had  a  half  attack 
to-day.  Pulse  averaged  from  this  date  54  in  the  minute  until  he  left  off  the  digitalis. 

June  13th. — Has  left  the  country;  has  not  had  any  attack  since  the  last  report :  takes  ^fij.  o.  n. 

June  1847. — Continues  perfectly  well;  has  not  had  any  more  attacks,  nor  taken  any  of  the 


EPILEPSY.  437 

medicine  since  the  15th  of  Axigust;  having  occasionally  previously  intermitted  its  use.  Is  now 
regularly  occupied  in  business,  active,  and  healthy  in  mind  and  body. 

In  another  case,  the  subject  also  being  fresh  complexioned  and  of 
sanguineous  temperament,  the  fits  were  arrested  for  six  months  by  the 
action  of  the  digitalis.  Previous  to  its  use  he  had  suffered  generally 
every  ten  or  fourteen  days,  then  having  four  or  five  fits  in  forty-eight 
hours.  After  the  commencement  of  the  medicine,  he  only  had  one,  and 
that  very  slight.  This  young  gentleman  had  a  constant  redness  of  the 
skin  above  the  eyebrows,  which  always  became  more  vascular  at  the 
period  of  the  attacks.  When  the  attacks  were  arrested  by  the  digitalis, 
this  redness  disappeared.  He  left  town,  and  when  away,  the  medicine 
was  not  continued  so  regularly,  and  the  redness  returned,  and  with  it 
the  attacks,  though  they  carne  singly,  and  only  two  in  number — the 
digitalis  again  controlling  them. 

I  believe  that  in  all  cases  of  fatal  epilepsy,  where  there  has  been  an 
autopsy,  the  vessels  of  the  brain  and  membranes  have  been  found  enor- 
mously distended,  and  in  some  there  has  been  extravasation. 

The  (Enanthe  crocata,  or  hemlock  water-drop-wort,  when  taken  in 
any  quantity,  produces  epileptic  convulsions.  I  was  present  at  ihe  post- 
mortem examination  of  four  convicts,  who  died  at  Woolwich  from  eat- 
ing it.  The  progressive  amount  of  sanguineous  effusion  on  the  brain 
was  in  proportion  to  the  length  of  time  they  survived.  The  seizure  was 
most  striking  and  instructive. 

In  all  there  was  great  congestion  and  some  sanguineous  effusion  on 
the  surface  of  the  brain  :  in  those  that  lived  the  longest,  the  quantity 
was  in  proportion  to  length  of  time  they  survived  the  seizure.  The 
first  man  died  in  about  an  hour,  and  the  last  in  about  two  hours. 

The  following  case  appears  to  corroborate  this  idea,  that  the  proximate 
cause  of  the  convulsions  is  a  rush  of  blood  to  the  brain,  if  it  may  be 
so  expressed. 

Case  80 — Ligature  of  the  common  carotid  in  epilepsy. — Michael  Cox,  pensioner,  set.  25,  san- 
guineous temperament,  and  muscular. — This  man  has  for  the  last  five  years  been  subject  to 
very  severe  epileptic  fits,  recurring  generally  about  once  a  fortnight.  He  was  first  attacked 
whilst  on  duty  at  Burmah,  but  without  any  previous  warning,  and  without  having  experi- 
enced any  attacks  of  illness.  He  had,  however,  for  some  time  been  much  exposed  to  the 
sun,  arid  undergone  great  fatigue.  He  had  lived  generally  temperately.  Since  the  first 
seizure,  the  epileptic  fits  have  generally  recurred  without  any  assignable  exciting  cause,  but 
have  been  also  occasionally  induced  by  intemperance.  He  has  not  been  able,  however,  to 
take  by  any  means  the  same  quantity  of  spirits  or  other  intoxicating  liquor  as  European, 
soldiers  generally  do;  a  very  small  quantity  comparatively  completely  overpowering  him, 
inducing  extreme  giddiness,  and  violent  throbbing  headache.  He  had  been  frequently  bled 
during  the  paroxysms,  but  subjected  to  no  other  treatment.  The  first  time  the  fits  were  par- 
ticularly brought  to  my  notice,  was  whilst  he  was  attending  a  hospital  as  orderly  over  one 
of  the  sick.  The  attack  was  extremely  violent,  and  his  efforts  so  powerful,  that  it  was  with 
difficulty  he  was  restrained  by  several  persons.  There  was  great  cerebral  congestion,  a 
feature  which  I  conceive  essential  to  every  attack  of  epilepsy,  and  by  preventing  which  (an 
object  I  believe  attainable  by  tying  one  or  both  carotids)  I  hope  to  cure  the  disease.  Still 
my  expectations  of  success  did  not  rest  entirely  upon  the  correctness  of  this  view  of  its  na- 
ture, which  might,  I  was  aware,  be  erroneous,  but  yet  the  epileptic  tendency  be  removed  by 
the  operation,  although  in  a  manner  different  from  that  expected  by  me. 

The  operation  was  performed  on  the  4th  February;  the  ligature  came  away  on  the  5th 
March. 

April  13th. — Since  the  operation  was  performed,  there  has  been  no  return  of  the  epileptic 
attacks,  nor  any  tendency  to  them.  He  has  experienced  also,  since  that  time,  a  great  im- 
provement in  his  general  health  and  feelings.  His  spirits  have  been  good — before  almost 


438  HUMAN   BRAIN. 

constantly  depressed,  and  he  could  not  stoop  for  any  time  without  giddiness  and  consequent 
danger  of  falling.  On  this  account  he  was  not  able  to  work  at  his  trade — that  of  a  shoe- 
maker— and  was  obliged  to  abandon  it.  Since  the  operation,  he  has  again  resumed  his 
work,  and  has  not  experienced  the  least  return  of  these  disagreeable  feelings.  He  has  also 
proved  the  efficacy  of  the  remedy  that  has  been  employed  by  very  hard  drinking,  which  he 
and  his  friends  considered  a  test;  it  required  a  large  quantity  of  spirits  to  make  him  drunk, 
and  he  did  not  afterwards  experience  the  headache,  and  gloomy  and  even  horrible  feelings, 
which  had  previously  always  followed  such  an  excess.  He  suffered,  as  he  told  me,  scarcely 
at  all.  His  whole  feelings  have  undergone  a  complete  revolution,  and  he  is  now  as  happy 
as  he  was  before  miserable  and  wretched.  > 

The  warning  which  I  have  already  adverted  to,  which  many  epilep- 
tics have,  viz.,  a  singing  noise  in  the  ears,  I  believe  arises  from  the 
dilated  carotid  artery  vibrating  in  the  carotid  canal  close  to  the  vestibule 
of  the  internal  ear.  I  regard  it  as  analogous  to  the  throbbing  produced 
by  the  dilated  artery  in  an  inflamed  part.  If  this  hypothesis  is  correct, 
it  may  be  considered  an  additional  argument  in  favor  of  this  theory. 

Dr.  Conolly*  observes  that  epileptic  patients  are  occasionally  warned 
of  the  approach  of  a  paroxysm  by  mental  excitement,  their  high  spirits 
becoming  to  their  friends  the  well-known  precursors  of  their  sufferings. 
This  must  arise  from  arterial  action.  It  is  analogous  to  the  mental  ex- 
citement induced  by  spirituous  liquors  ;  no  one  doubts  that  this  psychical 
effect  is  produced  by  a  physical  cause. 

In  reference  to  a  theory  which  was  broached  by  the  Wenzels,  that  the 
pituitary  gland  is  always  diseased  in  this  complaint,  Dr.  Bright  says,f 
"  Much  importance  had  been  ascribed  to  that  organ  as  connected  with 
epilepsy ;  I  have  not,  however,  as  yet  succeeded  in  tracing  this  connec- 
tion. Indeed,  the  structure  of  the  gland  is  very  apt  to  deceive  us  as  to 
its  changes;  for  in  its  healthy  state  it  is  a  firm,  fleshy  body,  so  sunk  in 
the  sella  turcica,  that  often,  in  attempting  to  bring  it  into  view,  we  lace- 
rate or  injure  it.  Still,  however,  there  is  no  doubt  that  it  is  sometimes 
out  of  proportion,  small  and  compressed  ;  at  other  times  larger  than  we 
should  suppose  healthy  ;  sometimes  the  seat  of  small  excavations,  and 
even  of  suppuration  ;  and  in  one  case  mentioned  in  the  present  volume, 
it  was  supposed  to  be  altogether  wanting.  It  is  by  no  means  impos- 
sible that  it  may  want  some  peculiar  influence  in  epilepsy  ;  but  I  have 
undoubtedly  seen  epilepsy  where  no  obvious  disease  existed  in  the  pitu- 
itary gland;  and  I  have  seen  cases  where  it  might  be  well  supposed 
to  be  small  and  dwindled,  but  this  depending  entirely  on  that  frequent 
occurrence  in  epilepsy — the  thickening  and  morbid  growth  of  the  pro- 
cesses of  the  basis  of  the  skull." 

Dr.  Bright  says,  "  I  believe  that  almost  always  during  the  epileptic 
paroxysm  either  as  a  cause  or  an  effect,  sanguineous  congestion  takes 
place  within  the  brain." 

Continued  cold  weather  sometimes  induces  epilepsy  in  old  and  feeble 
constitutions.  I  suppose  it  is  by  disturbing  the  circulation  that  it  pro- 
duces the  fit.  I  believe  that  the  severity  of  the  weather  last  winter 
brought  on  several  severe  forms  of  cerebral  disturbance. 

Case  81. — February  1st,  1847,  I  was  called  in  great  haste  to  visit  a  gentleman,  aged  56 
years,  though  in  appearance  much  older.  I  found  him  standing  in  his  counting-house  with 

*  An  Inquiry  concerning  the  Indications  of  Insanity,  by  John  Conolly,  M.  D.     London, 
1830,  p.  241. 
t  Op.  cit.,  vol.  ii.  p.  696. 


EPILEPSY.  439 

a  vacant  look,  and  apparently  lost  to  all  surrounding  objects ;  his  eyes  were  opened,  and  pu- 
pils quite  natural;  he  was  unable  to  answer  any  questions;  his  face  and  hands  were  cold, 
and  head  rather  hot;  the  pulse  was  small,  feeble,  and  about  severity.  I  then  heard  the  fol- 
lowing history  :  Shortly  after  coming  to  town  in  the  morning,  his  partner  observed  he  did  not 
seem  quite  so  clear-headed  as  usual.  This  dullness  of  intellect  gradually  increased,  until  his 
partner  became  alarmed,  and  thought  it  necessary  to  have  medical  advice.  I  learnt  that  his 
general  habits  were  quiet  and  penurious,  living  rather  below  par  than  above :  it  was  very 
clear  to  me  he  would  not  bear  any  depletion.  I  was  anxious,  therefore,  to  put  his  feet  in  hot 
water,  and  to  get  him  to  bed  as  soon  as  possible ;  but  before  I  could  get  him  into  a  cab  he 
was  seized  with  an  epileptic  fit ;  it  was  preceded  by  a  short  cry  and  accompanied  by  the 
usual  convulsions,  which  did  not  affect  one  side  of  the  body  more  than  the  other :  he  remained 
quite  insensible  about  a  quarter  of  an  hour,  and  then  very  slowly  recovered  his  conscious- 
ness ;  but  before  this  took  place  he  was  lifted  into  a  cab,  and  I  proceeded  to  his  home,  in  the 
neighborhood  of  London ;  by  the  time  he  had  arrived  there,  he  had  so  far  recovered  himself, 
that  he  soon  recognized  his  own  house,  and  he  said  something,  though  very  indistinctly,  to 
that  effect :  as  soon  as  I  got  him  into  the  house,  I  ordered  his  bed  to  be  warmed,  and  mustard 
poultices  to  the  calves  of  his  legs,  his  feet  to  be  immersed  in  hot  water. 

I  sent  for  his  usual  medical  attendant,  who  agreed  in  the  view  I  had  taken  of  the  treat- 
ment required.  Our  patient  soon  recovered  his  entire  consciousness,  after  the  general  warmth 
of  his  body  was  restored.  We  gave  him  some  cal.  and  rhubarb  that  night,  followed  by  a 
purgative  draught:  he  gradually  recovered,  but  for  some  weeks  suffered  much  from,  great 
debility  of  the  lower  extremities.  He  is  now  pretty  well,  though  he  does  not  feel  his  mind 
capable  of  much  attention  to  business.  The  rest  of  our  treatment  consisted  at  first  in  simple, 
bitter  infusions,  until  the  tone  of  the  stomach  seemed  restored  ;  afterwards  we  gave  him  the 
bichlorid.  of  mercury  in  sarsaparilla.  The  latter  medicine  was  given  in  consequence  of  the 
partial  paralysis  of  (he  lower  limbs.  He  has  had  no  more  fits. 

The  remote  causes  of  epilepsy  are  very  uncertain  ;  but  there  is  one  to 
which  our  attention  should  be  directed — I  mean  the  venereal  disease. 
Every  practical  surgeon  knows  how  often  this  poison  puts  its  paw  upon 
the  dura  mater.  We  have  already  had  occasion  to  consider  this. 
Syphilitic  inflammation  in  the  fibrous  tissue  not  unfrequently  produces 
deposits  and  thickening;  and  more  than  once  have  I  seen  epileptic  fits 
apparently  result  from  the  irritation  which  this  disease  occasions.  My 
attention  was  first  called  to  this  fact  by  my  friend  Mr.  Thomas  Copeland, 
a  surgeon,  who  related  to  me  a  case  of  the  kind  which  was  cured  by 
active  salivation.  The  following  case  occurred  in  my  own  practice,  and 
was  clearly  dependent  on  periosteal  mischief,  though  its  syphilitic  origin 
was  not  so  clear.  It  is  another  case  in  illustration  of  the  value  of  the 
tincture  of  iodine  in  cerebral  affections. 

Case  82.— Affection  of  the  periosteum  of  the  skull  and  membranes  of  the  brain. — May,  1843, 
A.  B.,  a  married  gentleman,  set.  27,  consulted  me  with  the  following  symptoms:  deafness  in 
both  ears,  occasional  feeling  of  giddiness,  more  in  the  morning  than  in  the  evening ;  but  he  soon 
feels  tired  from  exercise,  and  then  he  has  a  throbbing  in  his  head,  and  feeling  as  if  he  was 
going  to  be  giddy.  He  has  no  decided  pain  in  his  head,  but  he  feels  very  uncomfortable,  has 
occasional  retching,  but  does  not  bring  anything  off  his  stomach. 

Complexion  yellow  ;  pulse  100,  weak  and  irregular;  tongue  rather  pale,  but  not  furred  ; 
fauces  slightly  injected ;  he  has  occasionally  twitchings  of  the  arms  on  dropping  off  to  sleep, 
but  not  more  on  one  side  than  the  other.  He  showed  me  four  periosteal  swellings  on  the 
head,  two  on  the  left  side  of  the  forehead,  another  on  the  right  side,  and  a  fourth  over  the 
mastoid  process  of  the  temporal  bone  on  the  right  side:  all  these  contain  fluid. 

History. — Had  syphilis  seven  years  and  a  half  ago;  took  a  little  mercury,  but  neglected 
himself;  had  secondary  symptoms,  which  were  efficiently  treated  by  an  intelligent  practi- 
tioner with  the  oxymuriate  of  mercury  and  sarsaparilla ;  he  got  quite  well,  and  is  quite  cer- 
tain that  he  has  not  had  any  symptom,  of  any  kind,  of  this  disease  since.  About  three  years 
ago  he  was  thrown  out  of  his  gig  and  pitched  upon  his  head,  by  which  he  was  rendered 
insensible,  and  on  recovery  found  himself  deaf,  from  which  he  has  suffered  ever  since. 

Ordered  him  a  little  blue  pill  and  rhubarb  at  night,  and  draught  in  morning. 

7th. — Potass.  lodidi  gr.  iv.  bis  die.  Sarsa.  bis  t.  d.  Hydr.  c.  Greta  gr.  ij.  Pulv.  Rhei  gr.  j.  o.  n. 

]3th. — Head  shaved,  Tinct.  Iodine  to  the  head. 

18th. — Decidedly  better,  and  went  out  of  town. 


440 


HUMAN    BRAIN. 


24th. — Ditto,  less  giddiness,  no  sickness,  appetite  good. 

June  13th. — Complains  of  some  heat  in  his  head:  to  leave  off  the  Iodine,  and  use  a  cool- 
ing lotion. 

20th. — He  feels  so  perfectly  well  that  he  determined  to  go  back  again  to  his  business ;  he 
can  walk  six  or  seven  miles  without  inconvenience. 

Ordered  to  take  the  Iodine  and  Sarsa.  once  a-day  and  the  pill  at  night. 

His  place  of  business  is  hot,  and  he  feels  the  writing  so  much  that  he  is  obliged  to  give 
it  up  again:  he  remained  a  week  sleeping  out  of  town,  but  he  found  it  was  of  no  use. 

July  3d. — When  he  returned  to  me,  he  complained  much  of  pain  in  his  head,  and  twitch- 
ings  at  night.  I  ordered  him  an  active  purge,  three  leeches  to  the  head  over  a  spot  where 
he  has  a  fixed  pain.  Afterwards  Hydr.  c.  Greta  gr.  iv.  o.  n.  With  this  plan  he  soon  got 
much  better  again. 

13th. — Feeling  much  better,  but  weak — weaker  in  the  morning  than  after  he  has  been 
walking. 

August  17th. — Has  been  down  in  Kent,  living  very  quietly,  continuing  his  medicine,  Dec. 
Sarsa.  c.  lod.  and  Hydr.  c.  Greta.  Says  he  is  decidedly  better ;  walked  up  to  town  from 
Blackheath,  and  will  walk  back  again :  applied  some  more  Tincture  of  Iodine  to  the  head. 

September  5th. — Much  the  same,  feels  pretty  well,  but  says  there  is  a  certain  feeling  in 
his  head  which  is  not  quite  right :  ordered  him  to  resume  the  use  of  the  Tincture  of  Iodine 
to  the  head. 

22d. — Says  he  is  decidedly  better,  that  his  hearing  has  improved  wonderfully,  and  very 
little  feeling  of  weight  in  his  head. 

October  12th. — Says  he  is  perfectly  well  when  he  keeps  quite  quiet,  but  with  any  extra 
exertion  he  feels  a  slight  uncomfortable  sensation  about  his  head.  He  continued  the  Tinc- 
ture of  Iodine  till  within  a  few  days  ago,  when  he  thought  there  was  a  little  heat  in  his 
head;  he  continues  the  Hydr.  c.  Greta  gr.  ij.  alt.  n.  Mist.  lodin.  and  Sarsa.  once  a-day.  Orel. 
Hirud.  ij.  vertici  appl.  alt  die.  Hydr.  c.  Greta  om.  nocte. 

17th. — Much  better:  he  has  been  applying  two  leeches  every  other  night  to  the  upper 
part  of  his  forehead  by  my  advice,  on  account  of  a  slightly  uncomfortable  feeling,  occasion- 
ally at  the  vertex,  when  he  attempted  to  read.  This  feeling  he  says  seems  to  come  on  from 
any  slight  annoyance  which  irritates  him. 

November  6th. — Better,  but  has  still  a  slight  feeling  at  the  top  of  the  head  if  he  reads;  it 
extends,  in  a  zigzag  line,  as  if  there  had  been  a  cut  there-,  but  not  over  a  large  surface  as 
before.  Ordered  to  apply  Hirud.  ij.  alt.  nocte. 

24th. — Has  lost  everything  like  pain  or  uncomfortable  feeling  in  his  head,  but  he  had  a 
sensation  of  giddiness  on  the  22d,  on  getting  off  the  coach  and  walking  down  the  hill ;  he 
was  rather  exhausted,  not  having  had  his  regular  meal  in  the  middle  of  the  day ;  had  a 
slight  tremulous  and  faint  feeling  yesterday. 

Ordered  to  leave  off  his  Sarsa.  arid  Hyd.  c.  Greta,  and  take  Zinci  Sulph.  gr.  ij   t.  d. 

29th. — Still  uncomfortable  in  his  head  from  a  feeling  of  weakness  and  giddiness.  Or- 
dered Pil.  Rhei  Gal.  gr.  x.  H.  S. 

December  1st. — Has  acted  very  powerfully,  his  head  is  more  comfortable,  but  a  feeling 
of  great  weakness;  the  hearing  has  never  retrograded  at  all. — Ordered  Mist.  Camph.  c. 
Quin.  Pil.  Hydr.  gr.  ij.  o.  n. 

8th. — Better,  but  not  well ;  to  return  to  the  Iodine  Potass.  lodjn.  ex.  Sarsa.  bis  in  die,  and 
to  go  for  a  fortnight  to  the  sea. 

28th. — Says  he  is  now  quite  well,  that  after  being  two  days  at  the  sea,  he  felt  all  his  un- 
comfortable feelings  leave  him.  He  has  been  stopping  a  week  at  Blackheath,  and  has  con- 
tinued well. 

1845,  June  15th. — I  was  sent  for  during  the  night  to  see  Mr. .  When  I  arrived  at  3 

A.M.,  I  learnt  that  he  had  had  nine  fits  close  one  after  the  other,  the  first  occurring  about  ten 
o'clock  in  the  evening:  he  was  sensible,  and  knew  me  when  I  came  in.  I  learnt  that  he  had 
been  free  from  all  attacks  for  twelve  months,  and  had  been  in  very  good  health,  and  getting  stout; 
that  he  had  been  very  regular  in  his  habits,  and  very  strict  in  his  diet;  but  taking  bitter  ale  every 

day.  That  latterly  Mrs. had  thought  him  not  quite  so  well ;  that  he  had  been  restless 

at  night,  and  his  nose  inclined  to  bleed.  The  weather  has  been  very  hot  lately,  and  the  day 
before  he  went  down  to  Gravesend  with  his  brother ;  on  this  occasion  he  drank  a  pint  and 
a  half  of  bitter  ale — that  is,  about  half  a  pint  more  than  usual.  I  found  his  head  hot,  but 
he  did  not  complain  of  pain  except  when  he  raised  it  from  the  pillow.  I  put  his  head  over 
a  basin,  and  poured  cold  water  upon  it,  gave  him  five  grains  of  calomel,  ditto  of  Rhei  and 
Jalap,  and  a  draught  in  the  morning:  he  had  had  a  mustard  emetic. 

l(jth. — Going  on  well.  I  ordered  Liq.  Am.  acetatis  and  Tinct.  Lyttee,  &c.  No  beer  or 
other  stimulus. 

18th. — Going  on  well:  to  take  the  Argent.  Oxyd.  gr.  j.  t.  d. 

23d. — Free  from  all  pain,  and  is  quite  comfortable  j  he  came  to  see  me. 


EPILEPSY.  441 

When  epileptic  fits  once  occur  in  the  adult,  they  are  seldom  checked 
at  once,  generally  recurring  after  a  short  interval,  and  our  prognosis 
ought  to  be  very  guarded  and  on  the  whole  unfavorable.  But  some- 
times they  occur  singly,  or  limited  to  two  or  three,  and  never  reappear; 
but  this  is  the  exception  to  the  rule. 

Case  83. — In  the  month  of  February,  1843,  I  was  sent  for,  suddenly,  to  visit  a  gentleman 
who  was  reported  to  have  had  a  fit.  I  was  at  his  house  within  an  hour  from  its  occurrence, 
and  I  found  him  quite  sensible  and  free  from  pain,  both  in  the  head  and  elsewhere.  His 
brother,  who  was  with  him,  then  informed  me  that  he  had  been  complaining  that  he  was 
not  quite  well,  having  a  good  deal  of  pain  in  the  lumbar  portion  of  his  back,  which  he  sug- 
gested might  be  disease  of  the  spine,  and  begged  his  brother  to  feel  it ;  on  doing  so,  he 
winced  when  I  touched  a  particular  spot — which  gave  rise,  as  it  were,  to  a  sensation  which 
ran  up  from  this  spot  to  the  back  part  of  the  head,  arid  thus  extended  over  the  head — to 
lose  all  consciousness,  and  would  have  fallen,  if  his  brother  had  not  caught  him. 

His  brother  described  his  condition  as  exactly  the  same  as  an  ordinary  epileptic  attack,  of 
which  he  had  seen  many,  as  Mr.  H.'s  father  had  suffered  from  them  for  years.  He  was 
slightly  convulsed,  but  not  much.  Before  he  quite  recovered,  he  opened  his  eyes  with  a 
stupid  stare,  looking  quite  unconscious.  This  attack  was  soon  followed  by  another  exactly 
similar  to  that  he  had  two  hours  before  I  saw  him.  Ordered — A  draught  to  be  taken  at 
once:  Sp.  Amm.  Ar.  £fs.  Tinct.  Rhei  gj.  Inf.  Aur.  ^j.  and  two  pills  at  night;  Pil.  Rhei  co. 
gr.  v.  Pil.  Hyoscy.  gr.  v.,  and  to  keep  in  bed  till  I  see  him  next  day. 

18th. — Motion  full  of  bile,  and  healthy;  says  he  feels  comfortable;  pulse  80,  regular,  of 
fair  power ;  examined  the  spine — could  not  detect  any  symptoms  whatever  of  disease. 
Ordered — Inf.  Aurant.  co.  gvfs.  Sp.  Amm.  Ar.  gfs.  Sodee  Carbon  £j.  Tr.  Rhei  gij.  Mf. 
Mist,  cujus  cap.  sextam  partem  bis  in  die. 

I  attended  him  for  about  a  month,  prescribing  for  him,  after  I  got  the  digestive  organs  into 
order,  the  Sulphate  of  Zinc :  this  he  took  for  about  a  month,  and  then  left  it  off.  He  has 
been  very  careful  in  his  diet,  and  abstemious  in  regard  to  wine,  almost  abstaining  from  the 
latter,  which  he  used  to  indulge  in  before,  though  never  to  intoxication.  He  was  living,  at 
the  time,  in  rather  a  low  and  damp  situation,  which  I  persuaded  him  to  quit.  He  has  since 
lived  in  a  high  and  dry  spot,  and  has  remained  perfectly  well  ever  since. 

Cases  of  epilepsy  combined  with  hysteria  are  generally  more  tractable 
than  other  forms,  and  yield  frequently  to  very  simple  treatment ;  the  fol- 
lowing was  one  of  this  class. 

Case  84. — Eliza  Tittensor,  set.  20,  lives  at  home — domestic  occupation ;  healthy  appear- 
ance. 

First  fit  last  Christmas,  occasioned  by  fright  from  a  tipsy  man,  lasted  four  hours;  health 
previously  very  good,  not  subject  to  headache  or  any  other  ailment. 

March. — Fit  about  two  months  after  the  first,  occasioned  at  chapel  by  a  man  praying  very 
loud  near  her. 

September  23d. — Third  fit  today;  no  particular  cause;  complains  of  her  head  never  hav- 
ing been  comfortable  since  the  first  fit.  Made  an  issue  with  Potassa  Fusa  in  the  neck.  Pil. 
Rhei  c.  Cal.  gr.  x.  H.P.  mane. 

October  16th. — Argent.  Oxyd.  gr.  ij. 

23d. — She  complained  of  her  head  so  much,  and  as  I  felt  it  arose  from  the  stomach,  or- 
dered Inf.  Cinchon.  gvj.  Tinct.  Rhei  3jj.  Pot.  Carb.^ij.  Acid  Hydrocyan.  dil.^j.Sp.  Menth. 
Pip.  3J.  Coch.  Magn.  ij.  bis  die. 

November  29th. — Much  better,  free  from  fits,  head  easy. 

December  18th. — Has  continued  the  mixture  regularly,  free  from  headache,  feels  well, 
pulse  rather  small  and  quick,  excitable.  She  says  that  on  the  14th  she  sat  up  all  night  with 
her  aunt's  baby,  and  that  on  the  Sunday  evening  she  felt  as  if  a  fit  were  coming  on,  the 
sensation  being  a  rising  in  the  throat,  but  she  went  to  sleep  and  no  fit  occurred. 

January  27th.— Not  quite  free  from  headache,  but  always  finds  the  medicine  relieves  her 
head ;  had  not  had  any  fit  since  the  23d. 

February  8th.— Complains  much  of  her  head,  has  not  had  any  fits  since.  Ordered  Zinci 
Sulph.  gr.  ij  Ext.  Aconite,  gr.  j.  t.  d.  This  produced  sickness,  but  relieved  the  head :  to  take 
gr.  j.  Zinci  Sulph. 

20th. — To  leave  off  the  pills  and  take  the  mixture  again,  which  she  continued  till  March 
15th;  left  off  all  medicine,  and  dried  up  the  issue:  continues  quite  well. 

I  received  a  letter  from  the  medical  man  of  the  family,  stating  that  these  fits  were  epilep- 
tic, complicated  with  hysteria. 


442  HUMAN    BRAIN. 

The  various  forms  of  epilepsy  have  thus  been  classified  by  Esquirol, 
who  has  seen  as  much  of  this  disease  as  most  men  :  essential,  sympa- 
thetic, and  symptomatic. 

Essential  idiopathic  epilepsy  has  its  seat  in  the  brain  and  its  append- 
ages. It  may  be  divided  into  three  varieties  : — 

1.  Idiopathic  epilepsy,  produced  by  external  causes,  such  as  forcible 
compression  on  the  cranium,  contusions,  fractures,  coup  de  soleil. 

2.  Idiopathic  epilepsy,  depending  on  defective   organization  of  the 
cranium,  on  lesion  of  the  meninges  or  of  the  brain,  or  serous  or  sangui- 
neous extravasations  into  the  cavity  of  the  skull. 

3.  Idiopathic  epilepsy,  which  may  be  termed  nervous,  produced  by 
moral  affections  either  of  the  mother,  the  nurse,  or  the  patient  himself: 
among  the  moral  causes,  anger,  fright,  irritation,  are  the  most  to  be 
feared.     He  describes  sympathetic  epilepsy  as  presenting  five  varieties. 

The  first,  he  says,  is  connected  with  the  digestive  organs,  and  de- 
pends on  the  presence  of  indigestible  matter  in  the  alimentary  canal — 
intestinal  worms.  I  have  certainly  known  an  attack  of  epilepsy  brought 
on  in  a  patient  who  had  been  free  from  fits  for  twelve  months,  by  indi- 
gestion consequent  on  a  supper  of  cheese  and  radishes.  Still  it  must 
not  be  supposed  that  these  derangements  of  the  stomach  are  the  ultimate 
cause  of  epilepsy  ;  they  are  merely  the  exciting  causes  acting  on  an 
irritable  brain. 

The  second  still  less  deserves  the  name  of  sympathetic.  He  desig- 
nates it  angiotenique,  from  its  seat  being  in  the  arterial  system.  The 
suppression  of  menses,  haemorrhoids,  habitual  haemorrhages,  digression 
from  regime,  abuse  of  liquors,  provoke  these. 

The  third  has  its  seat  in  the  system  of  white  vessels,  humoral  epilepsy. 
Pale,  chlorotic,  rachitic,  and  scrofulous  persons,  are  predisposed  to  it ; 
the  retrocession  of  porrigo,  itch,  ulcers,  syphilis,  and  gout,  causes  this 
species. 

The  fourth  has  its  seat  in  the  organs  of  reproduction — epilepsia  geni- 
talis,  epilepsia  uterina,  the  abuse  of  venereal  pleasures,  onanism,  conti- 
nence, pregnancy,  accouchement,  are  the  ultimate  or  proximate  causes. 

The  fifth  has  its  seat  in  the  external  organs — epilepsia  sympathica  of 
authors.  Every  cause,  apparent  or  hidden,  which  irritates  some  of  the 
external  parts,  and  of  which  the  secondary  effect  radiates  towards  the 
brain,  produces  this  variety  of  epilepsy. 

But,  with  all  due  deference  to  this  distinguished  author,  I  doubt  the 
correctness  of  this  classification;  and  for  these  reasons — that  all  the  causes 
he  enumerates  as  productive  of  sympathetic  epilepsy,  are  causes  which 
are  capable  of  disturbing  the  circulation,  and  that  it  is  much  more  pro- 
bable that  this  disturbance  of  the  circulation  is  the  cause  of  the  epilepsy 
than  this  stalking-horse  called  sympathy.  It  is  possible  that  our  differ- 
ence may  be  one  of  words  merely,  and  that  what  he  would  call  sympa- 
thetic I  should  call  functional. 

Esquirol's  prognosis  of  epilepsy  is  as  unfavorable  as  that  of  our  own 
countrymen.  He  says — 

"  Sympathetic  epilepsy  is  more  easily  cured  than  that  kind  which 
arises  from  constitutional  causes,  yet  the  latter  is  not  always  incurable. 

" Epilepsy  seldom  attacks  those  children  who  have  humors  on  the  head. 


EPILEPSY.  443 

c<  Sometimes  this  disease  disappears  for  several  years,  and  then  recurs, 
without  any  assignable  cause. 

"Those  who  are  attacked  shortly  after  birth  seldom  recover;  if  they 
do  not  get  well  at  puberty,  they  remain  incurable. 

"  Those  who  become  epileptic  between  the  ages  of  three  or  four  often 
are  curable,  if  the  disease  be  treated  in  time. 

"Those  who  become  epileptic  a  little  before  puberty,  recover  at  the 
end  of  this  crisis. 

"  Those  who  become  epileptic  after  puberty,  are  sometimes  cured, 
although  Hippocrates  thought  otherwise. 

" Marriage  merely  cures  genital  epilepsy;  it  is  hurtful  in  the  other 
forms  of  this  disease.  A  pregnant  woman  who  becomes  epileptic  is 
exposed  to  great  dangers. 

"  When  the  fits  occur  at  shorter  intervals,  and  become  more  violent, 
death  is  to  be  feared. 

"Death  takes  place  during  the  prostration  after  the  violent  convul- 
sions, not  during  the  fit.  Epilepsy,  complicated  with  mania,  is  incur- 
able." 

Dr.  Prichard*  supports  the  doctrine  of  particular  determinations  of 
blood  to  distinct  parts.  He  says  we  often  find  a  patient  laboring  under 
intense  and  oppressive  pain  in  the  head,  with  vertigo,  flushed  and  heated 
in  the  face,  the  pulse  in  the  carotid  and  temporal  arteries  bounding,  while 
the  extremities  are  at  the  same  time  cold,  the  pulse  small,  and  the  ves- 
sels on  the  surface  generally  constricted.  If  the  feet  are  plunged  in  hot 
water,  and  rubbed,  hjood  taken  from  the  head,  and  cold  applied  there, 
the  pulse  at  the  wrist  and  the  carotid  soon  becomes  equalized,  and  the 
headache  is  relieved. 

Dr.  Prichard  believes  in  a  power  of  active  dilatation  in  the  artery. 
He  says,  "  This  property  of  the  arteries  is  precisely  that  which  Dr.  Parry 
has  described  under  the  term  Tonicity."  He  states  distinctly!  that  he 
considers  uthe  immediate  cause  of  an  attack  of  epilepsy,  or  that  physical 
change  which,  in  a  constitution  prepared  by  natural  predisposition,  or 
by  the  action  of  morbid  circumstances,  is  the  immediate  precursor  and 
occasion  of  the  fit,  appears  to  him  to  be  a  preternatural  influx  of  blood 
into  the  vessels  of  the  encephalon,  or  an  unusual  fullness  in  some  part 
of  the  vascular  system  of  that  organ."  Dr.  Prichard  then  goes  very 
fully  and  ably  into  his  reasons  for  this  opinion. 

The  following  case  illustrates  one  of  the  forms  somtimes  assumed 
by  this  Protean  disease.  It  is  only  by  a  knowledge  of  all  its  various 
shapes  that  we  can  understand  its  nature,  or  give  a  correct  prognosis 
when  consulted  on  the  first  appearance  of  it. 

Case  85.— Nov.  6th,  1846.— I  was  consulted  by  Mrs.  W.,  for  her  daughter,  C.  W.,  aet.  12, 
on  account  of  the  following  ailment.  She  suddenly  loses  her  consciousness ;  her  hands  fall, 
and  she  drops  anything  that  may  be  in  them ;  her  eyes  become  fixed  and  staring  ;  her  face 
very  red.  This  is  followed  by  a  sucking  or  convulsive  motion  of  the  lips,  but  not  elsewhere. 
No  cry  or  noise.  This  lasts,  at  the  most,  about  three  or  four  minutes,  then  she  turns  pale, 
and  falls  off  heavily  to  sleep,  and  wakes  again  in  about  half  an  hour. 

She  first  suffered  in  this  way  about  two  years  and  a  half  ago,  and  the  attacks  have  gra- 
dually increased  in  frequency  since :  they  now  sometimes  occur  three  or  four  times  in  the 
day.  She  seldom  passes  a  day  without  one  or  two;  not  more  liable  at  one  period  of  the 


*  Op.  cit.,  p.  82. 


444  HUMAN   BRAIN. 

day  than  another.  She  suffers  very  much  from  headache,  which  is  especially  over  the  fore- 
head. She  is  now  very  nervous,  and  very  timid,  but  was  not  so  as  a  young  child.  She  is 
intelligent,  and  is  very  clever  at  school.  Her  countenance  is,  on  the  whole,  good,  but  the 
lips  are  a  little  full,  and  the  complexion  a  little  muddy.  Her  mother  says,  when  her  head 
aches  she  is  always  very  pale.  Pulse  18,  17,  19,  in  the  quarter,  very  small,  and  a  little 
irregular.  Tongue  a  little  dry ;  forehead  hot ;  bowels  regular,. 

Ordered — No  study.  Pil.  Rhei  co.  gr.  vij.  Hydr.  Chlorid.  gr.  j.  M.  ft.  pil.  ij.  hie  nocte 
sumend.  Haust.  Senn.  co.  mane.  The  first  dose  did  not  operate  much,  but  the  evacuation 
was  very  dark  and  offensive.  Repeated  the  dose  the  day  after ;  four  motions — first  dark, 
then  more  natural.  She  has  not  had  any  kind  of  fit  since  she  took  the  medicine. 

Nov.  12th. — Ordered — Zinci  Sulph.  gr.  ij.  t.  d.  Pulse  22,  23. 

Nov.  20th. — She  had  two  or  three  fits,  gr.  iij.  t.  d. 

Dec.  4. — Has  had  six  fits  since  the  last  date,  but  she  says  that  her  head  is  much  better  : 
gr.  v.  t.  d. 

1 1th. — No  fits  since  the  last  date ;  her  head  feels  much  better.     Ordered  gr.  x. 

22d.— Gr.  v. 

30th.— No  fits ;  gr.  v. 

1847,  Jan.  5th. — She  reports  that  her  daughter  had  one  fit  on  the  31st  of  December,  five 
on  the  1st  of  January,  two  on  the  2d  of  January — eight  fits  in  all.  They  were  not  unusually 
severe ;  headache,  but  not  more  than  usual :  the  last  fit  was  the  worst.  Inf.  Digitalis  gij., 
Dublin  Pharmacopoeia. 

July  6th. — Has  not  been  taking  any  medicine  since  February;  she  has  had  the  attacks 
more  frequently  during  the  last  two  or  three  months,  but  they  are  not  quite  so  severe;  she 
has  more  warning,  which  she  describes  as  a  sensation  in  the  chest.  She  thinks  she  has 
sometimes  averted  an  attack  by  walking  about.  She  has  them  now  generally  four  or  five  in 
the  day,  at  intervals  of  a  week.  Ordered — Argent.  Oxyd.  gr.  j.  t.  d.  Pulse  24. 

The  following  case  presented  many  points  of  interest.  I  am  afraid 
from  the  severity  of  the  attacks  that  there  is  some  disease  of  brain. 
Whether  this  is  the  case  or  not,  the  disease  was  very  much  controlled 
by  the  digitalis. 

It  also  shows  the  importance  of  giving  medicines  to  tranquilize  the 
stomach  at  the  same  time  that  we  give  the  digitalis.  For  this  purpose 
I  have,  on  the  whole,  found  the  creosote  the  best ;  though  sometimes, 
as  in  this  case,  I  give  the  hydrocyanic  acid. 

In  marking  the  state  of  the  pulse  in  epilepsy,  I  always  note  the  num- 
ber of  pulsations  in  each  quarter  separately,  as  I  have  frequently  found 
much  difference  between  the  first  and  last  quarter.  (See  date  Nov.  21, 
in  the  following  case.)  When  this  happens  I  continue  to  count  it  for 
some  little  time,  and  n-ote  the  numbers  when  it  has  settled  down.  The 
reader  must  therefore  understand  that  the  figures  refer  to  the  quarter,  not 
to  the  whole  of  the  minute. 

Case  86. — Oct.  14,  1846. — M.  T.,  set.  13,  tall,  healthy-looking,  first  fit  two  years  ago;  but 
it  is  always  preceded  by  a  violent  pain  in  the  stomach  about  two  minutes  before  the  fit 
occurs.  She  always  cries  out  from  the  pain,  saying,  "Oh,  my  stomach!"  and  as  soon  as  she 
has  said  that,  she  goes  into  the  fit;  there  is  no  second  scream.  She  always  turns  very  red 
in  the  face  before  the  convulsion  occurs.  The  mother  says  that  at  night  she  has  a  different 
kind  of  fit,  distinguished  from  the  day  fit  by  its  not  being  preceded  by  the  pain  in  the  sto- 
mach; but  if  asleep  she  will  awake  and  jump  up,  and  say,  "I  am  going  to  have  my  night 
fits."  She  says  she  feels  very  queer  for  two  or  three  days  previously ;  never  complains  of 
singing  in  the  ears  or  swimming  in  the  head.  She  says  she  feels  as  if  she  could  cry  a  great 
deal ;  but  that  she  never  does ;  she  wishes  she  could  do  so.  Never  complains  of  pain  in 
her  head  except  after  the  fits. 

Very  excitable  girl,  very  violent  temper,  especially  before  the  fit.  She  is  sometimes  so 
bad  that  they  do  not  know  what  to  do  with  her.  The  mother  calls  her  a  very  cute,  clever 
girl ;  quick  at  anything.  Her  memory  is  now  affected. 

The  father  died  from  fungoid  tumor  in  the  skull ;  the  mother  alive  and  well. 

The  mother  attributes  the  disease  to  the  following  circumstance : — About  seven  years  ago 
she  had  an  eruption  (from  the  description  I  suppose  eczema)  on  the  back,  which  spread  up 
to  the  head  and  formed  a  large  wound.  This  was  cured  in  about  six  weeks,  and  the  girl 


EPILEPSY.  445 

has  never  been  well  since.  First,  she  could  never  keep  anything  on  her  stomach,  always 
very  sick ;  and  from  that  came  the  pain  in  her  stomach ;  for  five  years  she  used  to  cry  out 
four  or  five  times  a-day  with  the  pain  in  the  stomach ;  but  it  was  not  followed  by  any  fit. 

She  has  been  under  Dr.  Waller,  and  the  care  of  a  great  many  ditferent  persons.     She  was 

twice  treated  for  worms,  but  with  no  good  result.     They  then  applied  to  Dr.  L ,  the 

water-doctor,  under  whose  care  she  remained  for  three  months.     She  was,  after  this,  treated 

by  Dr.  D ;  after  him  by  Dr.  A ,  and  was  mesmerized  by  his  orders  twice  a-day  for 

about  two  months;  and  lastly,  they  applied  to  Dr.  Waller,  who  sent  her  to  me. 

She  now  has  the  fits  sometimes  four  or  five  in  the  day,  and  sometimes  only  once ;  they 
are  generally  more  numerous  every  fortnight. 

Last  Tuesday  night  she  had  seventeen. 

There  is  no  difference  iu  the  night  fits  and  the  day  except  in  the  warning ;  she  has  more 
warning  in  the  night. 

Once  she  had  a  fit  in  my  waiting  room.  T  heard  the  cry,  which  was  not  very  loud.  I 
went  into  the  room ;  she  was  then  struggling  slightly ;  the  convulsions  were  truly  epileptic, 
and  principally  on  the  left  side. 

Nov.  14th — Pulse  18,  20.  Inf.  Digitalis  (Dublin)  gij.  n.  et  m. 

IGth. — Pulse  18,  18,  17.     Two  bad  fits,  1  p.  M.  and  7  p.  M.  31  v. 

17th.— Pulse  23,  22,  23,  £j.  h.  s. 

18th.— Two  fits  yesterday.     Pulse  18,  20.  £x. 

19th. — Three  yesterday;  one  in  the  night;  four  in  all;  but  not  so  strong.  Pulse  24,  25, 
23.  ijfs.  n.  et  m.  Passed  a  large  quantity  of  urine. 

2Uth. — Only  one  yesterday;  none  in  the  night.     Pulse  23,  24.  ^j.  n.  et  m. 

2 1st. — None ;  but  she  has  had  more  headache.     Pulse  very  variable,  30,  20, 15.  ?j.  n.  et  m. 

22d.— One  in  the  night,  very  slight.     Pulse  25,  23.     Not  so  much  headache.  §j.  n.  et  m. 

23d. — None  in  the  night;  two  in  the  morning;  sleepy.  Pulse,  ten  minutes  alter  the  at- 
tack, full,  16,  16.  ^x.  n.  et  m.;  has  been  sick. 

24th. — Has  been  sick  again.     Pulse  23,  24.  £x.  n.  et  m. 

25th. — A  little  sickness;  two  fits  since  yesterday.     Pulse  25,  30,  27.  ^x.  n.  et  m. 

26th. — Little  sickness  ;  very  sleepy;  speaks  thick;  looks  silly.  Pulse  24.  Pulv.  Jalap  gr.  v. 
Cal.  gr.  iv.  Olii  carui.  TT\J.  M.  ft.  Pil.  ij.  h.  n.  sum.  Inf.  Senn.  ^j.  Magnes.  Sulph.  £j.  Acid. 
Sulph.  TT^iv.  Syrup.  Zingiber.  ^j.  mane. 

27th. — Was  very  ill  all  yesterday;  but  no  fits. 

28th. — Acid.  Hydrocyani.  dil.  TT^iij.  ex  aqua  jfj.  t.  d. 

29th.— No  fit. 

30th.— Acid.  Hydr.  dil.  tt\,iv.  aq.  gj.  t.  d.     Pulse  15,  16. 

Dec.  1st. — Very  queer  all  yesterday ;  a  very  bad  fit  this  morning.  Pulse  25,  26.  Inf.  Digi- 
talis ^j.  Quin.  Sulph.  gr.  j.  t.  d. 

2d. — Better.  Pulse  20, 21,  sharp.  Inf.  Digitalis  ^ifs.  Quin.  gr.  fs.  t.  d.  Pil.  Cal.  co.  gr.  v.  om.  n. 

3d. — Pulse  22,  20,  small.  Inf.  Senna  Jij.  Magn.  Sulph.  gfs.  Tinct.  Card.  co.  £ij.  statim. 
Inf.  Digitalis  ^j.  Quin.  Sulph.  gr.  fs.  n.  et  m. 

4th. — Creosote  TT\J.  t.  d.     Putse  20,  17,  intermittent. 

5th. — Ditto.     Pulse  23,  24,  regular. 

6th. — Ditto,  b.  d.  Pulse  very  peculiar,  stopping  merely  for  a  beat  or  two,  and  then  going 
on.  Pulse  14,  13. 

7th. — Creosote  TT\j.  t.  d.     Pulse  regular.  20,  21.     Ext.  Colocynth.  co.  gr.  iv.  om. 

8th. — Pulse  irregular,  16,  18. 

9th. — Felt,  yesterday,  for  some  time,  as  if  she  would  have  a  fit ;  but  had  none.  Went 
off  with  crying;  cried  for  an  hour.  Creosote  tt\J.  t.  d. 

10th. — Ditto.     Pulse  20,  20. 

llth. — Creosote  tnj.  t.  d.     Pulse  21. 

12th.— Ditto.     Pulse  20,  18,  18. 

13th. — Very  poorly  all  yesterday;  headache;  bowels  purged;  no  sickness;  bad  fits  at  half- 
past  nine;  interval  nine  days.  Pulse  25. 

15th. — Conf.  Aromat.  gfs.  (purged).  Mist.  Cretae  ^j.  Spirit.  Menth.  Pip.  gj.  bis  in  die. 
Pulse  22. 

16th. — Bowels  quieter. 

17th.— Rep.  Mist. 

18th. — Inf.  Digitalis  ^j.  n.  et  m. ;  fit  about  5  p.  M.,  after  having  a  dose  in  the  morning. 

19th. — Pulse  18.     Digitalis  ^ifs.  n.  et  m. 

20th.— Pulse  15.     Digitalis '^ifs.  n.  et  m. 

21st. — Pulse,  first  half  minute  37,  second  27,  slightly  irregular.     Digitalis  ,^ifs. 
.  22d. — Fit  yesterday ;  not  ill  to-day;  no  sickness  or  headache  5  pulse  full,  18,  18;  Creo- 
sote ny.  b.  d. 

23d.— Quite  comfortable ;  ditto. 


446  HUMAN   BRAIN. 

24th. — Had  eight  in  the  night,  very  severe,  two  in  the  morning.  1  p.  M-.  much  convulsed, 
especially  on  the  left  side;  headache.  Argent.  Oxyd.  gr.  j.  t.  d.  The  fits  continued  in  rapid 
succession,  but  becoming  weaker,  until  one  o'clock  in  the  day,  since  which  they  have  ceased. 
She  did  not  recover  the  use  of  her  left  hand  until  the  evening. 

29th. — Two  fits  in  five  days. 

Jan.  7th. — Seven  fits  during  the  day. 

10th.— Slight  fits. 

12th.— Pulse  20.     Continue. 

14th.— Two  fits. 

1 5th. — Continue  Argent.  Oxyd. 

22d. — Has  not  had  any  fits  since  the  last  report.     Rep. 

23d.— One  fit. 

25th. — Three  fits,  not  so  severe. 

26th. — Three  in  the  day,  slighter,  very  numerous  in  the  night. — Continue.  Did  not  lose 
the  use  of  leg,  only  of  the  hand. 

Feb.  3d. — Three,  violent. 

4th. — One  rather  slight. 

15th. — Ditto. 

16th. — Continue  the  Oxyd. 

20th. — One  slight  fit.     Continue  the  Oxyd. 

25th.— Three  slight  fits. 

26th.— Three  fits. 

27th.— Four  fits. 

28th. — First  fit  at  four  in  the  morning;  continued  for  twelve  hours,  with  scarcely  inter- 
mission ;  at  least  two  in  the  hour. 

March  I  st. — Seems  pretty  well  again ;  no  headache ;  speech  slightly  affected  ;  got  the  use 
of  the  hand  and  leg  sooner  than  usual.  Rep.  hirudines. 

10th. — Has  continued  the  pills. 

20th.— Rep. 

April  18th. — Had  several  fits  this  day;  but  much  slighter  than  they  had  ever  been  be- 
fore; very  different. 

May  5th. — None  since  ;  has  been  in  the  country — Blackheath;  has  continued  the  pills. 

21st. — One  bad  fit. 

23d. — Two  fits,  much  lighter  ones. 

June  7th. — One  fit. 

21st.— One  fit. 

28th.— One  fit. 

July  6th. — Fits  much  less  numerous;  has  applied  the  one  leech  every  month  to  each 
breast,  and  continues  the  pills  regularly. 

Dr.  Bright  considers  that  in  almost  all  the  cases  he  examined,*  "  a 
state  of  cerebral  congestion  has  existed  as  a  more  or  less  essential  part 
of  the  disease,  and  has  even  been  demonstrable  after  death."  It  is 
also  interesting  to  me,  that  when  he  found  decided  morbid  growths  or 
disease  within  the  skull,  in  none  of  all  these  "has  the  organic  change 
extended  into  the  medullary  substance ;  and  in  most  it  has  penetrated 
little  deeper  than  the  membranes  themselves. "  So  that,  in  fact,  the 
disease  has  not  extended  beyond  the  hemispherical  ganglion. 

Treatment. — If  there  is  evidence  of  organic  disease  of  the  brain,  the 
prognosis  must  necessarily  be  very  unfavorable,  and  little  can  be  expected 
from  treatment;  but  not  so  if  the  disease,  as  is  generally  the  case,  results 
from  functional  disturbance  of  the  brain.  Mild  mercurials  and  counter- 
irritation,  not  carried  so  far  as  to  depress  the  general  power,  should  be 
employed  when  the  disease  appears  solely  dependent  on  cerebral  disease. 
The  next  point  is  to  ascertain  whether  there  is  any  derangement  in  the 
function  of  any  other  viscus  besides  the  brain;  and  if  so,  to  employ  the 
most  efficient  remedies  to  set  it  right  again. 

The  digestive  organs  are  generally  in  fault,  and  they  ought  to  be  first 

*  Reports  of  Medical  Cases,  by  R.  Bright,  1831,  vol.  ii.  p.  553. 


EPILEPSY.  447 

attended  to.  Indeed,  no  course  of  tonic  medicines  ought  to  be  com- 
menced without  first  giving  a  full  dose  of  calomel  combined  with  colo- 
cynth,  rhubarb,  or  some  other  purgative,  and  the  character  of  the  faecal 
evacuations  examined.  I  never  saw  any  good  derived  from  blood-letting, 
and  I  have  seen  a  great  deal  of  harm  from  it,  I  bled  freely  in  one  or 
two  cases  some  years  ago,  under  the  impression  that  the  disease  was 
inflammatory,  when  there  was  a  decidedly  plethoric  state  of  the  system 
and  great  congestion  of  the  brain;  but  I  am  convinced  it  caused  a  re- 
petition of  the  attacks.  Even  the  application  of  leeches  either  hefore 
the  attack,  at  the  time,  or  afterwards,  only  does  harm.  Foville*  is  in 
favor  of  setons  to  the  neck,  and  the  periodical  application  of  leeches  to 
the  arms,  in  plethoric  individuals,  with  large  heads,  habitually  injected. 
He  also  recommends  the  internal  use  of  turpentine,  and  relates  a  case  in 
point. 

Epilepsy  is  not  unfrequently  caused  by  disease  of  the  heart,  generally 
hypertrophy  of  the  left  ventricle,  and  according  to  the  extent  of  the 
disease  may  therapeutic  agents  be  pushed ;  but  in  almost  all  cases  hydro- 
cyanic acid  will  be  found  of  great  value  in  subduing  irritability  of  this 
organ.  Local  depletion  in  the  cardiac  region  will  also  be  found  useful, 
but  it  must  rrot  be  carried  to  any  extent.  Three  or  four  leeches  every 
now  and  then  will  do  good,  whereas  twelve  or  twenty  would  excite  the 
heart.  I  have  also  found  a  belladonna  plaster  of  service,  but  it  is  in 
these  cases  that  digitalis  will  be  found  so  serviceable.  Aconite  in  small 
doses  will  also  be  indicated. 

For  a  knowledge  of  all  the  medicines  that  have  been  employed  in  the 
treatment  of  epilepsy,  I  must  refer  the  reader  to  Dr.  Copland's  erudite 
article  on  this  subject,  from  which  he  will  learn  that  nearly  every  drug 
in  the  Pharmacopeia  has  been  used  at  one  time  or  another.  I  have  found 
the  sulphate  of  zinc,  the  nitrate  of  bismuth,  the  oxyde  of  silver,  and 
digitalis,  more  or  less  useful.  I  will  first  speak  of  zinc.  In  the  two 
succeeding  cases  its  exhibition  was  followed  by  the  cure  of  the  disease. 
I  have,  however,  frequently  given  it  since,  but  with  only  temporary  bene- 
fit, and  some  of  the  cases  have  recovered  with  other  means;  and  I  have 
treated  successfully  with  other  medicines  some  cases  where  it  had  been 
given  to  a  great  extent  by  other  practitioners  without  any  effect. 

Case  87. — J.  B.,  set.  49,  married  man,  has  two  children,  piano-forte  maker ;  has  lived  freely  ; 
but  for  twelve  months  before  the  attack,  had  abstained  altogether  from  liquors,  till  within  two 
months  of  the  first  fit — during  this  latter  period  had  been  in  the  habit  of  taking  sips  of  brandy 
during  the  day,  amounting  sometimes  to  five  or  six  glasses.  Nothing  particular  in  regard  to 
the  venereal  passion;  has  always  lived  with  his  wife.  He  was  first  attacked  in  March,  1841, 
and  consulted  me  early  in  May,  in  the  same  year :  his  own  account  of  the  case  is  as  fol- 
lows:— 

"Before  the  first  attack,  I  had  a  violent  pain  in  the  head  the  whole  of  the  day,  and  worse 
towards  evening;  and  while  I  was  conversing  with  a  friend,  rny  memory  failed  me  for 
some  minutes  before  the  fit,  so  that  I  could  not  explain  what  I  meant.  The  fit  lasted  for 
about  twenty  minutes,  was  accompanied  with  foaming  at  the  mouth,  and  violent  struggling; 
it  was  a  long  time  after  the  fit  before  I  recovered  my  senses,  and  I  was  quite  unconscious  of 
what  had  occurred. 

"  The  second  attack  was  about  six  weeks  after ;  I  then  had  bad  pain  in  the  head  for  two 
or  three  hours  before :  but  took  very  little  notice  of  it.  I  lost  my  sight,  and  went  a  few 
paces,  and  fell  down.  I  cannot  say  whether  it  was  violent  or  not,  as  I  was  in  the  street  at 
the  time.  I  had  another  attack  the  next  night,  while  in  bed :  it  was  not  so  violent  as  the 


*  Diet  de  Med.  et  cie  Oiir.  Prat.,  vol.  vii.,  1831. 


448  HUMAN    BRAIN. 

first,  but  it  was  some  time  before  I  recovered  my  senses."  I  ordered  him  an  aperient,  and 
having  got  his  secretions  generally  in  a  healthy  state,  I  gave  him  the  sulphate  of  zinc — 
ordering  a  total  abstinence  from  stimulating  liquors.  The  next  attack,  the  first  after  I  saw 
him,  was  brought  on  by  stooping ;  it  did  not  last  more  than  ten  minutes.  He  had  another 
the  same  evening — slight.  The  next  week  he  had  another,  but  recovered  sooner  than  be- 
fore ;  and  he  had  notice  of  their  coming.  Each  attack  was  between  eight  and  ten  in  the 
morning. 

August  5th,  1842. — Has  been  free  from  attacks  for  at  least  twelve  months:  had  an  attack 
about  1  A.  M.,  which,  from  his  wife's  account,  was  one  of  the  ordinary  character  of  epilepsy. 
He  has  strictly  adhered  to  the  plan  of  a  total  abstinence  from  liquors  since  I  saw  him  ;  he 
can  only  account  for  it  by  the  circumstance  of  his  having  been  a  little  flurried  lately,  about 
money  matters.  For  the  last  day  or  two  he  has  found  himself  sighing  very  deeply,  and 
quite  unconsciously.  Has  felt  a  little  dimness  of  vision  when  about  his  work.  Ordered— 
Calomel  gr.  v.  Jalap  gr.  vii.  stat. 

Sept.  8th. — Had  an  attack  last  night. 

Jan.  6th,  1843. — Had  another  attack,  which  he  feared  was  coming  on,  from  a  feeling  of 
lowness  of  spirits  and  slight  headache,  but  it  was  so  slight  that  he  paid  no  attention  to  it ;  he 
has  left  off  the  sulphate  of  zinc  for  the  last  six  weeks — only  aperients  since.  Ordered  to 
renew  the  zinc. 

March  2d. — Left  off  the  zinc,  feeling  quite  well ;  takes  Pil.  Rhei  co.  gr.  v.  p.  r.  n. 
^  Feb.  7th,  1845. — Has  returned  for  advice,  having  had  a  fit  the  night  before;  has  been 
free  from  attacks  for  one  year  and  six  months,  that  is,  from  the  6th  January,  1843,  till 
August,  1844,  when  he  was  in  the  country.  He  attributed  it  to  stooping  to  wash  his  feet: 
it  came  on  in  the  night.  He  merely  took  some  aperient  medicine,  and  had  no  return  till 
the  last  just  mentioned ;  "but  he  had  severe  starting  of  his  limbs  on  falling  gff  to  sleep,  and 
feels  a  tingling,  and  attributes  it  to  wind  on  the  stomach,  as  when  it  is  expelled  he  is  easy. 

On  the  day  previous  to  the  occurrence  of  the  last,  he  had  severe  headache,  and  cold 
shiverings,  which  he  could  not  attribute  to  indigestion,  as  he  has  strictly  observed  my  rules 
of  diet.  He  had  recourse  to  the  Cal.  and  Jalap,  with  the  aperient  draught,  which  operated 
well,  but  did  not  avert  the  attack.  He  is  free  from  headache,  and  feels  wrell,  only  sore  from 
the -cramp.  Pulse  76;  tongue  dry,  but  clean.  Ordered  Zinci  Sulph.  gr.  ij.  t.  d.  Pil.  Rhei 
co.  p.  r.  n.  He  took  the  Zinc  for  about  six  months.  ,;  ,;{_ 

June  30th,  1847. — Has  abstained  in  toto  from  all  intoxicating  liquors,  and  continued  well 
since  the  last  date,  not  having  had  any  fit  for  nearly  two  years  and  a  half. 

The  following  case  illustrates  an  important  point  in  regard  to  the  ad- 
vent of  epilepsy,  namely,  that  it  is  often  preceded  by  frequent  and  very 
prolonged  attacks  of  syncope.  I  always  regard  frequent  fainting  fits  in 
the  young  of  either  sex  as  a  very  serious  premonitory  symptom  of  ap- 
proaching epilepsy. 

Case  88.— I  was  consulted  on  the  llth  of  November,  ^837,  by  Mrs.  W.,  on  behalf  of  her 
son,  who  had  been  suffering  for  some  years  from  epilepsy:  he  was  a  well-grown  lad,  11§ 
years  old,  with  a  vacant  look,  and  rather  a  dull  complexion.  From  the  mother  I  had  the 
following  particulars : — 

"Memorandum  of  my  son's  illness. — He  was  born  in  India.  He  was  not  a  healthy  child 
after  he  had  attained  his  second  year,  but  never  had  fits,  not  even  while  teething.  When 
two  years  old  he  lost  the  use  of  his  limbs,  and  could  not  stir  a  joint  without  the  most  acute 
pain ;  continued  in  this  state  from  March  to  November,  when  he  quite  recovered ;  the  suc- 
ceeding year  a  similar  attack  at  the  same  period.  During  these  attacks  there  was  no  eruption 
about  him,  but  from  the  knees  to  the  ankles  there  was  an  appearance  of  red  and  black  spots, 
as  if  he  had  been  tattooed,  but  this  was  only  skin  deep,  there  being  nothing  above  the  skin. 
The  medical  opinion  was,  that  the  blood  was  poor,  the  effect  of  an  unhealthy  clime,  Assam. 
Since  he  has  been  in  England,  no  similar  attack  has  taken  place.  His  stomach  was  always 
large,  till  two  years  ago,  when  his  sides  were  much  blistered  and  leeched,  and  he  was 
treated  for  a  diseased  liver.  About  eight  months  ago  he  complained  of  frequent  attacks  of 
pain  in  his  head,  as  if  he  had  a  weight  there.  The  pain  in  his  head  was  succeeded  by 
giddiness,  for  which  his  temples  were  leeched,  and,  bleeding  profusely,  he  fainted  at  the 
time,  and  again  the  next  morning;  he  continued  daily  to  faint,  sometimes  from  six  to  eight 
times  in  an  hour;  never  struggled  or  changed  color  in  these  fainting  fits;  always  came  to 
•with  cold  water  or  salts.  Previous  to  fainting,  he  complained  of  pain  extending  from  the 
lower  part  of  his  stomach  to  the  chest.  He  now  began  to  have  a  horror  of  water,  or  of 
smelling  anything  during  the  faints.  From  April  to  July  he  had  on  an  average  never  less 
than  eight  fits  in  the  day,  and  sometimes  as  many  as  twenty.  In  July  the  fits  began  to 
change  in  character,  still  occurring  daily:  sometimes  he  was  much  convulsed,  and  at  other 


EPILEPSY.  449 

times  groaned ;  he  would  sing,  dance,  and  talk  of  things  he  would  not  do  when  in  a  right 
state  of  mind.  During  these  fits,  though  with  his  eyes  shut,  he  knew  the  footstep  of  every 
one  that  entered  the  room;  knowing  any  one  by  the  feel  of  their  hands,  walking,  dressing 
himself,  picking  out  his  clothes  from  those  of  his  brothers  by  the  feel,  with  his  eyes  quite 
shut;  he  was  exceedingly  violent  if  opposed." 

The  intellect  was  a  good  deal  weakened  when  he  first  came  to  me  for  advice,  and  his 
mother  feared  he  was  becoming  idiotic. 

The  medical  treatment  was  very  simple.  At  first  I  attended  to  the  digestive  organs,  and 
after  awhile  I  gave  him  the  sulphate  of  zinc  in  doses  of  two  grains.  This  he  continued  for 
about  three  months,  and  ultimately  quite  recovered,  and  is  now  serving  with  the  army  in 
India. 

The  medicines  that  I  have  found  most  beneficial  are  the  oxyde  of 
silver  and  the  infusion  of  digitalis.  In  two  cases,  already  related,  the 
infusion  of  digitalis  succeeded  after  the  oxyde  of  silver  and  bismuth  had 
been  tried,  and  failed.  But  as  far  as  I  have  yet  seen,  the  infusion  of 
digitalis  is  adapted  to  young  and  excitable  subjects,  the  silver  to  older 
patients,  where  the  disease  is  more  confirmed  and  the  fits  do  not  occur 
so  frequently.  For  a  knowledge  of  the  value  of  the  oxyde  of  silver  in 
these  cases,  and  the  best  mode  of  using  it,  I  am  indebted  to  my  late  and 
lamented  friend  Dr  James  Johnson.  For  the  digitalis  I  am  indebted  to 
Dr.  Corrigan,  whose  observations  were  copied  in  the  Medical  Gazette* 
from  the  Dublin  Hospital  Gazette.  Dr.  C.  states  that  the  digitalis  has 
long  been  a  quack  remedy  for  epilepsy  in  Ireland,  but  that  it  was  used 
in  such  tremendous  doses  that  frequently  its  effects  were  terrific. 

It  occurred  to  Dr.  Corrigan  that  if  he  could  succeed  in  saturating,  as 
it  were,  the  nervous  system  with  its  sedative  influence  without  the  risk 
of  inducing  those  frightful  effects  which  follow  on  the  exhibition  of  a 
large  dose,  he  would  gain  an  important  point  in  practical  medicine. 
After  many  trials  of  its  preparations  he  gives  the  preference  to  the  infus. 
digitalis  of  the  Dublin  Pharmacopoeia,  but  he  cannot  too  strongly  insist 
on  the  greatest  attention  being  paid  to  see  that  the  leaves  are  well  pre- 
pared and  of  the  latest  gathering.  The  mode  of  the  administration  is  to 
begin  with  3J.  of  the  infusion  every  night  at  bedtime,  increasing  it  after 
a  week  to  3iss.,  and  after  another  week  to  3ij.,  beyond  which  it  is  rarely 
necessary  to  go,  and  continuing  it  till  sickness  of  the  stomach  and  dilated 
pupils  are  observed,  when  the  dose  is  to  be  diminished  by  ^ss.  or  3j., 
till  the  maximum  dose  that  can  be  borne  without  inconvenience  be  as- 
certained, which  quantity  is  to  be  taken  for  two  or  three  months.  Given, 
in  this  way  its  administration  is  attended  with  no  inconvenience  beyond 
an  occasional  attack  of  slight  sickness  of  stomach  in  the  morning,  or 
headache,  &c.,  when  the  medicine  is  to  be  discontinued,  and  a  day  or 
two  are  to  be  allowed  to  pass  over  before  resuming  its  use.  With  the 
exception  of  these  symptoms  there  is  no  perceptible  effect,  except  slow 
action  of  the  heart,  and  the  patient  is  able  to  continue  his  ordinary  avo- 
cations. 

In  the  use  of  digitalis  as  a  sedative  to  the  heart's  action,  I  have  never 
found  it  act  as  a  diuretic;  and  this  I  account  for  by  not  having  combined 
it  with  other  diuretics,  as  the  neutral  salts,  or  the  bichloride  of  mercury, 
&c.  I  have  not  spoken  of  the  state  or  quantity  of  urine,  as  I  soon  found 
it  was  uninfluenced  by  it.  Dr.  Munkf  has  made  some  excellent  obser- 

*  Vol.  36,  p.  1473. 

t  Dr.  Munk  on  the  Action  of  Digitalis,  p.  295,  Guy's  Hospital  Reports,  for  October  1844. 

29 


450  HUMAN    BRAIN. 

rations  on  this  subject,  which  I  have  not  room  to  quote  here  so  fully  as 
I  should  wish,  but  I  must  extract  those  which  conclude  his  paper.  "  A 
remedy,  it  has  been  well  observed,  can  scarcely  serve  and  hurt  the  con- 
stitution at  the  same  time ;  and  digitalis,  where  it  gradually  and  in  a 
kindly  manner  abates  the  heart's  action,  or  stimulates  the  kidneys,  never, 
according  to  my  experience,  accumulates,  or  produces,  in  a  prominent 
degree,  those  alarming  symptoms,  upon  which  writers  have  so  amply 
dilated." 

The  best  account  of  the  use  of  digitalis  as  a  medicine,  historically  and 
therapeutically,  will  be  found  in  a  treatise  by  Dr.  William  Hamilton,  of 
Bury  St.  Edmund's,  1807.  It  is  well  worthy  of  perusal.  Many  cases 
of  epilepsy  are  complicated  with  menorrhagia,  and  in  these  cases  I  found 
the  digitalis  additionally  useful.  Dr.  Ferriar,  who  has  published  an 
essay  on  this  subject,  states  that  he  prescribed  it  with  great  benefit  in 
hemorrhage  generally,  but  especially  in  menorrhagia. 

In  relating  a  few  more  of  the  cases  in  which  I  have  found  the  digitalis 
beneficial,  I  shall  again  advert  to  its  use  when  there  is  any  disturbance 
of  the  uterine  functions,  and  the  propriety  of  combining  it  with  other 
medicines.  When  I  give  the  digitalis  I  always  keep,  or  have  kept  for 
me,  at  the  commencement,  a  daily  account  of  the  pulse,  numbering  the 
pulsations  in  the  quarter,  as  related  in  the  next  case;  after  I  have  em- 
ployed it  for  some  months,  I  am  then  satisfied  with  a  report  every  other 
day. 

Case  89. — November  7th,  1846. — A.  B.  C.,  set.  16,  a  tall,  delicate-looking  girl,  with  a  pleas- 
ing countenance,  has  had  fits  since  she  was  seven  years  old.  The  first  followed  scarlatina, 
with  an  interval  of  two  or  three  months.  She  had  none  of  the  usual  sequelae  of  the  dis- 
ease. Father  and  mother  died  of  phthisis.  She  was  in  strong  convulsions  for  a  short  time, 
and  then  insensible  for  above  four  hours.  She  first  menstruated  at  13,  but  not  regularly — 
three  and  five  weeks.  She  generally  has  the  attacks  every  month  in  bed,  three  at  a  time. 
In  the  day  she  has  often  a  warning  of  an  attack,  so  as  to  cry  out,  "My  nose."  Her  grand- 
mother has  found  that  by  pinching  the  nose  she  has  averted  the  attack.  The  fits  are  not 
ushered  in  with  a  decided  cry.  She  recovers  her  senses  in  about  ten  minutes,  and  then 
falls  off  to  sleep.  She  says  that  the  sensation  it  comes  on  with  is  a  trembling  in  her  bowels. 
She  cannot  describe  it  in  any  other  way.  No  headache  before  the  fits,  but  always  after, 
which  is  removed  by  sleep.  Bowels  regular ;  intellect  has  been  very  good,  but  is  now  be- 
ginning to  fail.  She  had  ascarides  five  or  six  years  ago,  but  none  lately. 

Last  attack,  three  or  four  days  ago,  three  fits;  two  days  after,  one  more;  two  days  after, 
one;— five  in  all.  Pulse  23,  21,  22,  in  the  quarters.  Ordered,  Inf.  Digitalis  (Dublin  Phar- 
macopoeia) £\\.  h**c  nocte. 

7th. — This  night  she  took  the  medicine,  and  had  three  fits,  and  vomited  violently. 

8th. — She  had  the  commencement  of  an  attack,  but  it  appeared  to  be  averted  by  pinching 
the  nose  and  pouring  some  sal  volatile  into  her  mouth.  Inf.  Dig.  £ij.  h.  n. 

9th. — Pulse  29,  quarter  of  minute;  ^ss. 

10th.— Pulse  20 ;  Svj. 

llth.— Pulse  20;  §j. 

12th.— Pulse  20,  18,  18;  gx. 

13th.— Pulse  19. 

14th. — Has  had  several  threatenings,  but  no  complete  attack  ;  pulse  22,  19,  19,  19;  £x. 

15th.— Pulse  19;  £j. 

16th.— Pulse  18;  ^x. 

17th. — Pulse  21,  21,  21;  ^iss.  Has  not  had  any  complete  fit  since  the  7th,  but  severe 
threatening;  she  also  complains  of  such  horrid  thoughts  of  cutting  throats,  and  jumping  out 
of  windows.  She  is  now  menstruating,  and  has  been  so  this  week;  it  is  now  always  very 
profuse. 

18th.— Pulse  19;  £iss. 

19th. — Pulse  20;  Ziv. 

20th.— Pulse  16;  gij. 

21st.— Pulse  16,  16;  no  complete  attack,  but  several  tremblings;  hiccup  and  sickness. 


EPILEPSY.  451 

Continue  Pil.  Rhei  co.  gr.  viij.  bac  nocte.     Cal.  gr.  ij.     Inf.  Senna  ^j.     Syrup.  Zingib.  £j. 
Magn.  Sulph.  gij.     Acid  Sulph.  dil.  tt\,iv.  mane. 

22d.— Pulse  16,  17,  18,  17. 

23d.— The  aperient  has  acted  very  freely;  the  pulse  is  sharp  and  full — 20,  18;  £x. 

24th.— Pulse  20 ;  5Jxij. 

25th.— Pulse  18;  £xiv. 

26th. — Pulse  18,  17,  18 ;  vomited  this  morning;  gvj.  Pil.  Rhei.  co.  gr.  vj.  Cal.  gr.  j. 
Inf.  Senn.  ^j.  Magn.  Sulph.  gj.'  Acid  Sulph.  dil.  TT\,v.  Syrup.  Zingib.  £j.  mane ;  to  be  taken 
to-night,  if  the  sickness  continues. 

27th.— Pulse  17  ;  Pit.  et  H.  ut  supra  hac  nocte, 

28th. — Pulse  20;  two  fits. 

29th.— Pulse  20;  one  fit;  Rep.  Haust.  Digit.  £vj. 

30th.— Pulse  19,  16,  18  ;  Inf.  Digit.  |j.  Pil.  Rhei  co.  gr.  v.  p.  r.  n. 

December  1st. — Pulse  20 ;  no  attack ;  gj.  gij. 
•  2d. — Pulse  18,  17,  18,  18;  one  nervous  attack;  £x. 

3d.— Pulse  16,  18,  18,  18;  none;  £x. 

4th. — Pulse  20;  three  slight;  ^xij. 

5th. — Pulse  18,20;  several;  3pdj. 

6th. — Pulse  18,  20;  four  slight;  ^xij. 

7th.— Pulse  20,  18,  20,  20;  three  slight  attacks;  £xij. 

8th.— Pulse  18,  20,  18;  ^ij. 

9th.— Pulse  18 ;  Pil.  Rhei  gr.  v.  h.  n. 

10th — Pulse  18;  one  or  two  slight  attacks;  Rep.  H.  Digit,  gij. 

llth.— Pulse  19,  19,  19;  ^ij. 

12th.— Pulse  20  ;  ^xiv.    ""  ^ 

13th. — Pulse  20;  £xiv. 

14th  to  17th. — Repeated  nervous  attacks,  but  slight;  gxiv. 

18th. — The  same;  Hyd.  Chlor.  gr.  iij.  h.  n.  Haust.  Aper.  mane. 

20th. — Pulse  19,  20;  omit  the  Digitalis. 

21st. — Pulse  20,  19;  Rep.  Hs.  Digit,  gxiv.  The  nervous  affections  frequent,  and  exces- 
sively low  in  the  animal  spirits. 

22d. — Pulse  18,  19;  two  more  complete  fits;  Creosote  TT\J.  Panis.  q.  s.  ut  fiat  Pil.  j.  ter 
in  die. 

23d. — Pulse  the  same  as  day  previous. 

24th — The  same.  On  this  occasion  she  was  not  ill  as  usual,  previous  to  the  menstrual 
period,  but  the  fits  came  after ;  they  were  not  so  severe  as  usual,  for  she  did  not  even  know 
of  their  occurrence.  The  menstrual  discharge  was  not  so  profuse  as  usual.  The  nights 
have  been  better  since  taking  the  Creosote. 

26th. — Pulse  18,  18,  19,  19;  Creosote  lt\J.  t.  d. 

28th— Pulse  18;  Rep.  Pil. 

30th. — Pulse  18,  17;  two  nervous;  Rep.  Pil.  Creosote 

31st.— Pulse  18,  19;  Rep.  Pil. 

January  2d,  1847.— Pulse  18,  17;  Rep.  PiL 

4th.— Pulse  18,  18;  Rep.  Pil.  Creosote. 

5th.— Pulse  20 ;  Rep. 

6th.— Pulse  20,  20. 

9th.— -Pulse  20,20;  Pil.  Creosote;  b.  d.;  Inf.  Digitalis;  gss.  nocte. 

llth.— Pulse  20,  20;  Rep.  H.;  gj. 

13th. — Pulse  20;  Rep.  H.;  ^iss.  nocte. 

14th. — Pulse  18,  16 ;  half  attacks  less  frequent  and  less  severe  than  they  were;  5iss. 

16th.— Pulse  18;  Rep.  Digit. 

18th. — One  slight. 

19th.— Pulse  20,  20;  slight  attacks,  not  as  it  used  to  be:  Rep.  Digit.  ?ij. 

20th.— Pulse  18,  18,  18;  gij. 

22d.— Pulse  18;  gij. 

24th.— Pulse  18,  18;  gij. 

26th — Pulse  18,  16,  17;  gij.  Pil.  Rhei  co.  gr.  v.  h.  n.  Nervous  attacks  less  frequent, 
some  days  none;  less  severe. 

28th.— Pulse  19, 18.     ' 

30th.— Pulse  17,  16;  Rep.  Digit 
February  1st. — Pulse  17,  16. 
2d.— Pulse  17,  16;  Rep.  gij. 
4th.— Pulse  17,  16;  Rep.  gij. 
6th.— Pulse  16,  16,  17;  Rep.  5ij. 
8th.— Pulse  18,  20. 


452  HUMAN   BRAIN. 

10th.— Pulse  18,20;  |ij. 

12th. — Pulse  19,  20;  nervous  attacks  frequent  in  the  last  day  or  two;  this  is  the  case 
after  aperient  medicine. 

13th.— Pulse  18,  19,  18;  ^ij.;  Creosote  TT\j.  b.  d. 

14th. — Whole  attack  in  the  morning,  after  rising,  but  not  so  long  or  so  severe. 
15th. — Another  about  7,  after  rising;  pulse,  11  A.M.,  20,  21,  20;  Inf.  Digitalis,  g  iss.  nocte, 
ditto,  ^ss.  mane;  omit  Creosote;  Hirud.  ij.;  singulae  mammae. 
16th. — Menses  returned;  slept  well. 
17th.— Pulse  18,  18,  18;  one  fit. 
18th. — Another  fit,  stronger. 

19th.— Pulse  36,  18;  Inf.  Digitalis  gij.     Spirit  Menth.     Pip.  £j.  o.  n.    Creosote  n\j.    Ext 
Rhei  gr.  iij.     Misce  fiat  pil.  j.  bis  in  die  sumenda. 
22d.— Pulse  18,  18. 

23d.— Pulse  18,  18;  §j.  o.  n.  Rep.  Creosote  b.  d. 
25th.— Pulse  18,  18. 
26th.— Pulse  16, 17,  18;  gss.  o.  n. 
28th.— Pulse,  17,  18. 
March  1st.— Pulse  17,  17,  16. 
2d.— Pulse  18,  18;  gij. 
4th.— Pulse  16,  16. 
6th.— Pulse  17,  16,  18:  gij. 
7th. — ^iss.  alt.  nocte. 
8th.— Pulse  16,  17,  17;  5ij. 
9th.— Pulse  16, 17,  16;  §iss.  o.  n. 
10th.— Pulse  17,  17,  17. 
12th.— Pulse  17,  17 ;  Rep.  H.  Digit,  ^iss. 
13th.— Pulse  16,  16,  17;  gij.  o.  n. 

14th. — Fit,  5  A.  M.,  slight;  about  the  monthly  period,  but  the  menses  have  not  appeared. 
15th.— Pulse  17,  17,  17. 

16th.— Pulse  18,  17;  Ziss.  o.  n. 

18th.— Pulse  20,  20;  §  iss. 

19th.— Pulse  17,  17,  17;  liss. 
20th.— Pulse  17, 17, 17;  |iss. 
22d.— Pulse  17, 16,  17;  giss. 
23d.— Pulse  16,  16;  ^iss. 

25th.— Pulse  15,  16,  16. 

26th.— Pulse  17,17,  17,  17;  one  fit;  giss. 

27th.— Pulse  22,  23,  23,  23;  two  fits  this  night;  giss. 

28th. — Pulse  16,  17,  16;  one  fit  in  the  night,  with  sickness; — four  fits  in  all;  no  Digitalis 

to-night :  the  vomiting  is  so  severe,  that  Mrs. was  afraid  to  give  her  the  Digitalis.    She 

took  the  Creosote  twice  in  the  day.     The  bowels  having  been  confined,  she  has  generally 
had  the  Pit.  Rhei  co.  gr.  v.  every  other  night;  the  last  fit  very  slight. 

29th. — Pulse  17,  17,  17,  18;  no  Digitalis  last  night;  Inf.  Digitalis,  ^iss.  o.  n.     Creosote 
n\j.  b.  d.     Pil.  Rhei  co.  gr.  v.  p.  r.  n. 

31st.— Pulse  15,  16,  16,  15;  Rep.  H.  Digit. 

April  1st. — Pulse  16,  16;  Rep.  Digit. 

3d.— Pulse  16,  17,  16,  16. 

4th. — Some  threatening  of  an  attack. 

5th.— Pulse  16,  17,  17 ;  Rep.  Creosote.  Rep.  Digital,  gij. 

6th.— Pulse  16,  16;  Rep.  Digit,  gij. 

8th.— Pulse  17,  16,  18,  18;  Rep.  Creosote.  Rep.  Digit.  §ij. 

10th.— Pulse  18,  20,  20,  18. 

llth.— Pulse  15,  16,  16;  Rep.  Digit  £ij. 

12th.— Pulse  16,  17. 

14th.— Pulse  17,  16,  17. 

15th.— Pulse  16,  17;  Rep.  Dig.  t^ij. 

16th.— Pulse  20,  19;  Rep.  Dig.  5jij. 

18th.— Pulse  16;  Rep.  Dig.  |ij. 

19th. — Pulse  20,  20 ;  after  dinner  and  exercise.  • 

20th.— Pulse  16,  15;  gij. 

22d. — Pulse  20,  20;  after  trundling  her  hoop;  5ij. 

23d.— Pulse  18,  18;  gij. 

24th.— Pulse  1 9,  20. 

25th.— Pulse  18,  19. 

27th.— Pulse  16,  16,  18 ;  Ferri  Sulph.  gr.  j.    Creos.  %].    Aloes  co.  gr.  v.  o.  n.     She  men- 


EPILEPSY.  453 

strnaled  this  morning.  On  Saturday  evening,  that  is,  the  24th,  she  had  a  very  slight  fit, 
slighter  than  they  have  known  them  before.  Ord. — Ferri  Sulph.  gr.  j.  Creosote  TT\J.  b.  d. 
Inf.  Dig.  ^ij.  o.  n.  Pil.  Aloes  co.  gr.  v.  o.  n. 

28th. — Pulse  16,  16,  18;  gij.  o.  n.  Creosote  Tuj.  Ferri  Sulph.  gr.  j.  Quinin.  Sulph.  gr. 
j.  bis  in  die.  Pil.  Aloes  co.  gr.  v.  o.  n. 

29th.— Pulse  17,  17;  ^ij.  o.  n. 

30th.— Pulse  17,  18. 

May  2d.— Pulse  17,  16,  16;  Rep.  H.  Digit. 

3d.— Pulse  17,  16;  Rep.  Dig. 

4th.— Pulse  16,  16. 

5th. — Pulse  15,  16, 15;  Rep.  Dig. ;  has  passed  the  monthly  period  without  any  attack,  the 
first  time  this  has  occurred. 

7th.— Pulse  14,  15,  15. 

9th.— Pulse  15,  16. 

10th.— Pulse  16,  14 ;  Rep.  Omnia. 

12th.— Pulse  18,  18,  17. 

14th.— Pulse  16,  17;  Rep.  Inf.  Dig.  Ferri  Sulphatis  gr.  j.  Pil.  Aloes  c.  Myrrh  gr.  ij.  b.  d. 
Pil.  Cal.  co.  gr.  v.  o.  n. 

15th.— Pulse  17,  18;  Rep.  Digit. 

16th.— Pulse  16,  17. 

17th.— Pulse  16,  17. 

18th. — Slight  fit  this  morning;  sickness  and  vomiting  afterwards;  bowels  freely  opened. 
Ord.— Pil.  Col.  h.  n.  Inf.  Dig.  gj.  h.  n.  Omit  Pil.  Ferri. 

19th.— Pulse  20,  20.     Rep.  Inf.  Dig.  gj. 

20th.— Pulse  18,  18.     Rep.  Ferri.  Inf.  Dig.  giss. 

22d.— Pulse  17,  18. 

24th.— Pulse  16,  16.     Rep.  Omnia. 

25th.— Pulse  19,20,  19.  gij. 

26th.— Pulse  17,  18,  17,  at  noon. 

27th.— Pulse  17,  17,  11  A.M.  gij.     Omit  Ferri. 

28th. — Pulse  17, 16,  17,  at  noon;  in  the  evening,  17,  18,  17. 

29th.— Pulse  17,  17,  18,  18,  vespere.     Inf.Jij. 

30th.— Pulse  17,  17,  17,  ditto.     Rep.  Dig.  Jij. 

31st. — Pulse  16,  18.     Rep.  Dig.  gij. 

June  1st. — Pulse  17,  18,  17,  late  in  the  evening,  after  a  long  walk, 

3d.— Pulse  15,  15,  1 1  A.  M.     Rep.  Ferri.      Inf.  gij. 

6th. — Pulse  16,  16,  in  the  evening. 

7th.— puise  16,  16,  16,  16,  vespere. 

8th.— Pulse  14,  15,  15.     Rep.  Ferri.     Inf.  Digitalis  gij. 

9th.— Pulse  17,  16,  o.  n. 

10th.— Pulse  17,  16,  17.     Rep.  Digit,  ^ij. 

llth. — Very  slight  fit,  six  weeks  interval.     Pulse  18,  17,  18.  §ij.     Continue  Ferri  quotidie. 

12th.— Pulse  17,  17,  17,  17. 

14th.— Pulse  16,  16,  16.     Rep.  Inf.  Digit,  gij. 

15th.— Pulse  17,  16,  17.     Rep. 

17th. — Pulse  21,  21,  vespere. 

18th. — Pulse  18,  18,  18,  mane,  Rep.  Omnia. 

19th.— Pulse  17,  17,  17. 

21st. — Pulse  17,  17,  17,  in  the  morning,  after  a  walk  of  three  miles. 

22d.— Pulse  15,  16,  16.     Rep.  Omnia. 

24th.— Pulse  16,  17,  17. 

25th.— Pulse  14,  15,  14.     Ferri  Sulph.  gr.  ij.  b.  d. 

27th.— Pulse  19,  20,  19.  giss.  h.  n. 

28th. — Pulse  15,  15,  15.     Ferri  in  die  Inf.  giss.  o.  n. 

30th.— Pulse  16,  15,  16.     Rep.  Digit. 

July  2d. — Pulse  16,  17.  Ferri  Sulph.  gr.  ij.  in  die.  Inf.  Digit,  ^iss.  o.  n.  Feels  quite 
well ;  very  few  nervous  feelings  now. 

I  have  already  stated  that  I  have  not  found  the  Digitalis  so  successful 
in  old  standing  cases  of  epilepsy  in  the  adult  as  in  the  younger  subject; 
but  I  have  always  found  it  exert  a  very  decided  controlling  power  over 
the  disease.  This  was  very  strikingly  exhibited  in  the  following  case, 
which  is  also  interesting,  as  showing  that  its  long-continued  use  is  some- 
times attended  with  injurious  effects.  The  case  receives  an  additional 


454  HUMAN   BRAIN. 

interest  from  the  clear  way  in  which  it  is  detailed  by  Mr.  Greenhow, 
of  Tyneraouth,  by  whose  advice  I  was  consulted.  Its  connection  with 
a  cutaneous  eruption  is  important. 

Case  90. — Mr.  S.  T.  P.,  set.  21,  was,  during  infancy  and  boyhood,  the  subject  of  a  chronic 
cutaneous  affection,  extending  over  the  hands,  arms,  and  lower  part  of  the  face,  and  which 
only  finally  disappeared  within  eighteen  months  or  two  years  of  his  first  epileptic  seizure. 
After  the  cessation  of  the  eruption  he  became  enormously  fat  for  his  period  of  life,  and  ac- 
quired a  pale,  pasty  kind  of  complexion.  He  has  at  no  time  manifested  any  symptom  of 
aberration  of  rnind  or  deficiency  of  intellect,  and  is  at  the  present  period  (Oct.  1845),  in 
much  better  general  health  than  at  the  period  when  I  was  first  consulted.  He  is  also  much 
less  corpulent,  and  has  lost,  in  a  great  measure,  the  peculiar  character  of  the  countenance 
before  described. 

Mr.  S.  T.  P.  has  always  been  prone  to  derangements  of  the  stomach,  accompanied  by  great 
tendency  to  sickness,  which  he  has  been  accustomed  to  encourage  by  copious  draughts  of 
warm  water;  and  by  occasional  headache  and  feverishness.  His  tongue,  always  more  or  less 
furred,  has  a  swollen,  sodden  kind  of  appearance,  and  is  also  deeply  indented  by  the  teeth. 
The  pulse  is  regular,  rather  small,  and  averages  70. 

His  father  took  a  prominent  part  in  the  election  of  1841,  and  he,  being  one  of  his  father's 
clerks,  was  exposed  to  great  mental  as  well  as  physical  excitement.  At  5  A.  M.,  July  23, 
1841,  (at  that  time  being  17  years  of  age,)  he  was  awakened  out  of  his  sleep  by  a  sensation 
of  cramp  in  the  left  leg,  which  was  immediately  followed  by  an  epileptic  fit.  I  did  not  see 
him  during  the  attack,  which  lasted  a  very  short  time,  but  found  his  stomach  much  deranged 
on  the  following  day.  At  first  the  attacks  succeeded  one  another  at  regular  intervals  ;  gene- 
rally between  the  hours  of  4  and  5  A.  M.,  and  were  always  preceded  by  the  aura  epileptica, 
which  awoke  him  and  gave  time  to  alarm  his  father  and  mother,  who  slept  in  the  adjoining 
room.  If  at  any  time  he  had  a  slighter  paroxysm,  it  was  most  frequently  succeeded  by  a 
second  on  the  following  morning.  The  fits  have  generally  been  followed  by  sleep  ;  but  there 
has  hitherto  been  no  tendency  to  coma,  and  whenever  headache  or  feverishness  have  oc- 
curred on  the  following  day,  they  have  clearly  been  referable  to  disorder  of  the  digestive 
organs.  There  has  from  the  first  been  no  biliary  derangement,  and  the  action  of  the  bowels 
is  regular  and  efficient  without  the  aid  of  medicine. 

During  the  last  two  years  T  have  been  only  very  occasionally  called  to  see  him  ;  but  the 
epileptic  attacks  still  occur,  though  less  regularly  and  with  longer  intervals.  Various  modes 
of  treatment  having  been  diligently  tried  without  any  very  decided  benefit,  medicine  has  of 
late  only  been  had  recourse  to  when  the  attack  has  been  succeeded  by  feverishness  or  un- 
usual derangement  of  the  stomach.  He  has,  however,  within  about  a  year  had  three  or  at 
most  four  attacks  in  the  day-time,  and  in  the  waking  state.  On  the  occurrence  of  the  first 
of  these  day  seizures  I  was  sent  for,  and  found  him  just  recovering,  although  unable  to  speak. 
It  was  only  after  free  vomiting,  and  the  lapse  of  half  an  hour,  that  he  recovered  his  speech, 
or  could  walk  steadily.  On  that  occasion  he  attributed  the  paroxysm  to  a  fright;  but  the 
other  day-attacks  have  been  preceded  by  no  apparent  cause. 

Taking  the  history  of  the  case  into  consideration,  I,  in  the  first  instance,  directed  my  atten- 
tion to  removing  the  evident  derangement  of  stomach,  which  complicated  if  it  was  not  the 
indirect  cause  of  the  epilepsy.  All  excitement  was  strictly  forbidden,  and  a  very  restricted 
diet,  with  abstinence  from  stimulants,  was  prescribed.  Small  doses  of  Pil.  Hydrarg.  with 
stomachic  tonics  were  administered,  and  his  bowels  were  kept  free  by  the  use  of  mild  laxa- 
tives. Exercise  in  the  open  air  was  enjoined;  and  he,  for  many  months,  entirely  gave  up 
attendance  to  business.  An  issue  was  also  made  in  his  arm,  from  which  a  free  discharge 
was  kept  up  for  many  consecutive  months.  After  he  had  had  three  or  four  attacks  he  was 
seen  with  me  in  consultation  by  Drs.  Greenhow,  of  North  Shields,  and  White,  of  Newcastle  ; 
and,  at  their  suggestion,  the  Pil.  Hydrarg.  was  continued  until  the  gums  became  tender. 
Afterwards,  at  Dr.  White's  suggestion,  he  took  the  following: — R.  Pulv.  Rad.  Dictamni. 
Exotic  £iss.  Pulv.  Rad.  Zedoar.  Flav.  gr.  xv.  m.  in  ch.  v  divid.  cap.  j.  primo  mane  quotidie 
ex  aqua.  He  was,  at  the  same  time,  restricted  to  vegetable  and  farinaceous  food ;  all  kinds 
of  meat,  animal  broths,  stimulants,  tea  and  coffee,  being  prohibited.  The  bowels  were  kept 
free  by  daily  doses  of  castor  oil,  and  a  free  eruption  was  kept  up  on  the  arms  for  several 
weeks  by  the  use  of  the  following  liniment — R.  Ol.  Croton  gj.  Sp.  Terebirithinae  gvj.  T. 
Lavend.  co.  2JJ.  m.  ft.  Liniment. 

The  powders  were  increased  in  strength  from  time  to  time ;  but  after  persevering  in  their 
use,  without  any  decided  benefit  for  seven  months,  they  were  finally  abandoned.  He  has 
also  tried  the  Nit.Argenti  twice  for  about  four  months,  with  a  few  weeks'  interval  between 
the  twocourses ;  likewise  the  Liq.  Potassio.  Arsenic.  All  these  plans  of  treatment  having  failed, 
he  has  long  ceased  to  employ  internal  remedies  systematically, although  attention  to  diet  and 
regimen  has  been  frequently  and  stringently  enforced. 


EPILEPSY.  455 

On  the  receipt  of  this  report  I  wrote  to  Mv.  Greenhow  to  the  following  effect : 

"Oct.  15th,  1845. — I  believe  that  epilepsy  is  generally  dependent  on  disturbance  of  the 
organs  of  digestion  and  generation  when  it  is  not  occasioned  by  positive  disease  of  the  nerv- 
ous system.  I  have  no  doubt  that  Mr.  S.  T.  P.'s  attacks  are  referable  to  such  disturbance, 
and  not  to  any  organic  disease  of  the  brain  and  spinal  cord  ;  and  if  this  view  is  correct  we  may 
possibly  effect  a  cure,  though  it  would  not  be  right  to  hold  out  any  certain  prospect  of  such 
a  desirable  result  after  so  much  has  been  tried  in  the  way  of  medicines  ;  but  I  never  despair 
now.  after  the  recovery  of  a  friend  who  had  the  disease  for  fifteen  years,  beginning  at  about 
the  age  of  twenty. 

"  I  could,  indeed,  mention  five  or  six  cases  of  adults  who  have  recovered  under  similar 
treatment.  The  general  plan  I  will  now  explain,  with  the  understanding  that  it  is  only  to 
be  carried  out  under  your  own  supervision.  Medicine  is  certainly  of  great  service  in  this 
disease,  but  diet,  &c  ,  are  even  more  important,  or  rather,  I  should  say,  that  the  one  is  value- 
less without  the  other. 

"  First,  with  regard  to  diet : — 

"  Breakfast. — Plain  dry  toast  or  home-made  bread,  without  butter ;  milk  and  water  if  milk 
agrees,  if  not,  weak  tea  or  cocoa. 

"  Luncheon,  about  one. — A  small  sandwich  and  a  biscuit,  with  a  tablespoonful  of  brandy 
in  half  a  tumbler  of  cold  water,  without  sugar. 

"  Dinner,  not  later  than  five. — Plain  roast,  boiled,  or  broiled  mutton  :  no  other  meat.  Mealy 
potato.  Farinaceous  puddings,  but  no  pastry,  no  fruit,  no  preserves,  no  dessert  of  any  kind  j 
the  same  quantity  of  brandy  and  water;  no  wine  or  beer. 

"  Tea  should  not  be  a  real  meal,  only  a  little  very  weak  tea,  and  toast  without  butter. 

"  Cold  shower-bath  the  first  thing  after  getting  out  of  bed,  warm  water  for  the  feet.  If 
unaccustomed  to  the  shower-bath,  to  be  used  tepid  for  the  first  few  days.  A  short  run  or 
walk  before  breakfast.  As  much  walking  exercise  in  the  day  as  can  be  taken  without  fa- 
tigue; no  horse  exercise;  no  mental  excitement ;  no  sexual  excitement ;  to  sleep  on  a  matress, 
the  feet  well  covered.  If  the  feet  are  cold  on  going  to  bed,  to  put  them  in  warm  water. 
The  medicines  I  have  prescribed  on  another  sheet.  In  all  the  cases  in  which  this  plan  has 
succeeded,  it  has  not  succeeded  immediately,  but  the  attacks  have  gradually  lessened  in  force 
and  frequency. 

"Sincerely  hoping  that  we  shall  meet  with  success,  I  will  now  subscribe  myself,  yours 
very  sincerely,  "  S.  S." 

"Argent.  Oxyd.  gr.  j.  Ext.  Cal.  co.  gr.  ij.  t.  d.  Liq.  Potass.  Brandith.  ^iss.  Tinct.  Todin.  co. 
3J.  Spirit  JEth.  Nit.  ^iss.  sumat  cochl.  min.  ex  cyatho  vinoso  aqua  bis  in  die  surnat." 

"Tynemouth,  2ist  November,  1845. 

"My  Dear  Sir — I  have  intended  writing  to  you  for  some  time  past,  having  in  the  first  in- 
stance deferred  doing  so  until  I  was  satisfied  the  plan  you  suggested  was  agreeing  with  my 
patient  . . . 

"Mr.  S.  T.  P.,  I  am  glad  to  say,  appears  to  be  going  on  well.  A  few  days  previously  to 
commencing  the  medicine  he  had  a  threatening  without  the  succeeding  fit,  which  he  entirely 
escaped,  and  he  has  had  two  slight  fits  since.  I  have  made  him  discontinue  the  -sandwich 
for  luncheon,  and  substitute  plain  bread  or  biscuit,  as  he  has  become  fatter  since  he  followed 
your  plan ;  in  other  respects  he  pursues  it  strictly." 

"Tynemouth,  25th  February,  1846. 

"  My  Dear  Sir — I  almost  fear  you  must  have  thought  me  inattentive  in  allowing  so  long  a 
period  to  elapse  without  again  giving  you  a  report  of  our  patient's  progress.  I  have  not, 
however,  thought  it  necessary  to  trouble  you  sooner,  as  no  material  change  has  taken  place 
since  my  last,  and  you  had  led  me  to  expect  the  improvement  would  be  very  slow.  He  has 
now  pursued  the  plan  for  four  months,  and  although  the  number  of  attacks,  during  that  time 
as  compared  with  the  same  period  in  the  four  preceding  years,  has  been  greater,— this  year 
there  have  been  seven  seizures  between  the  17th  of  November  and  the  present  date,  and 
previously  they  have  never  exceeded  five. — I  think  his  general  health  improved  by  the 
treatment  you  suggested;  and  his  father  is  decidedly  of  opinion  that  the  attacks  are  shorter 
in  duration  and  less  violent  than  they  used  to  be.  Under  these  circumstances,  I  am  disposed, 
provided  you  agree  with  me.  in  the  opinion,  to  pursue  the  plan  for  some  time  longer.  That 
you  may  be  better  able  to  judge  of  his  state  as  to  the  frequency  of  attacks  under  the  different 
plans  of  treatment  he  has  pursued,  I  inclose  a  comparative  statement  of  his  case  on  these 
points  during  the  same  period  in  each  year  since  he  was  first  seized.  I  ought  also  to  men- 
tion that  his  tongue  is  improved  in  character,  and  that  his  skin  has  assumed  a  more  healthy 
appearance.  He  dined  with  some  friends  on  the  26th  of  November,  and  evidently  disordered 
his  stomach.  To  this  I  attribute  the  attacks  on  Nov.  27th,  Nov.  30th,  and  Dec.  2d ;  at  this 
time  he  had  a  good  deal  of  sickness;  headache,  and  lassitude,  with  depression  of  spirits  and 
feverishness.  Have  you  seen  a  plan,  recommended  I  believe  originally  by  Dr.  Corrigan,  for 


456  HUMAN   BRAIN. 

treating  epilepsy  with  Digitalis  ?     I  remember  to  have  seen  a  short  account  of  it  in  one  of 
the  Journals,  but  too  brief  to  enable  me  to  judge  of  its  merits. 

"  Believe  me,  my  dear  Sir,  yours  very  sincerely, 

"E.  HEADLAM  GREESHOW." 

In  answer  to  this  I  wrote  to  advise  the  omission  of  the  oxyde,  as  I  was  afraid  of  discolor- 
ation of  the  skin,  as  he  had  taken  it  four  months,  and  I  recommended  the  use  of  the  Digi- 
talis as  prescribed  by  Dr.  Corrigan,  having  now  had  a  good  deal  of  experience  of  its  efficacy. 

"Tynernouth  Place,  10th  Sept.  1846. 

"  My  Dear  Sir — I  have  not  thought  it  necessary  to  trouble  you  earlier  with  any  statement 
of  the  progress  of  Mr.  S.  T.  P.'s  case.  I  have  kept  tolerably  minute  notes  of  his  state  since 
I  last  wrote  to  you,  and  proceed  to  give  you  a  brief  abstract  of  them.  The  last  attack  of 
epilepsy  before  commencing  Dr.  Corrigan's  plan,  was  on  the  14th  of  February.  On  the  26th 
he  commenced  taking  the  Digitalis,  on  which  day  his  pulse  was  64 ;  ten  days  afterwards 
(March  7th)  the  pulse  had  risen  to  80.  He  had  attacks  on  the  7th,  17th,  and  28th  of  March. 
That  on  the  28th  was  so  slight  that  he  did  not  become  entirely  insensible,  although  he  had 
the  aura,  convulsions,  and  loss  of  speech.  The  dose  was  gradually  increased,  until  on  the  31st 
of  March  he  took  2£  ounces  of  the  infusion,  prepared  according  to  the  Dublin  formula  (equal 
to  5  oz.  Pharm.  Lond.).  On  April  1st,  he  was  very  sick  5  pulse  60,  weak  and  irregular; 
headache,  pains  in  the  limbs,  and  along  the  course  of  the  spine.  The  Digitalis  was  now 
omitted  for  three  nights,  when  his  pulse  having  resumed  its  natural  character,  he  recom- 
menced with  the  original  J  oz.  doses.  In  four  days  his  pulse  fell  to  50.  On  the  8th  day 
(April  12th),  having  taken  l^oz.  the  evening  before,  he  complained  of  pain  in  the  shoulders, 
chest,  arms,  back  and  limbs.  April  13th. — Sickness;  pains  much  increased ;  slight  headache; 
pulse  90,  small  and  feeble,  but  regular.  From  this  time  the  Digitalis  ceased  to  affect  the 
regularity  of  the  pulse,  which,  contrary  to  its  former  and  more  usual  effect  was  henceforward 
uniformly  increased  in  frequency  as  the  patient  came  under  its  influence.  The  draught  was 
omitted  on  the  13th  of  April,  but  resumed  on  the  14th.  On  the  16th  the  pain  had  increased ; 
there  was  also  tenderness,  generally,  over  the  abdomen,  more  intense  at  the  epigastrium ; 
tongue  coated,  with  redness  of  the  tip;  rapid  emaciation.  On  the  17th  he  was  covered  with 
an  eruption,  closely  resembling  measles,  which  extended  over  the  back,  shoulders,  chest, 
abdomen,  arms,  limbs,  and  face.  No  urtication.  On  the  18th  the  redness  had  disappeared 
from  the  tongue,  but  the  tenderness  at  the  epigastrium  continuing,  eighteen  leeches  were 
applied.  On  the  20th,  the  tongue  had  the  tremulous  character  observed  in  delirium  treme»s; 
and  on  the  22d  his  hands  were  also  tremulous.  On  the  25th  of  April  he  had  a  threatening, 
•which,  after  walking  two  or  three  times  across  the  floor,  passed  off,  without  a  regular  attack. 
This,  is  the  first  time  he  ever  had  the  aura,  and  other  feelings  of  an  impending  fit,  without 
their  being  succeeded  by  one.  He  continued  the  Digitalis  for  the  most  part  regularly,  during 
this  period,  only  omitting  it  once  or  twice  for  a  single  night,  when  the  symptoms  were  most 
urgent.  The  dose,  at  this  time,  averaged  l£  oz.  (equal  to  3  oz.  P.  Lond.),  but  varied  ac- 
cording to  circumstances.  The  eruption  continued  with  but  slight  alteration  for  many  weeks, 
only  acquiring  a  bluish  leaden  kind  of  tinge,  and  being  accompanied  by  slight  desquamation 
of  the  cuticle.  On  the  16th  of  May  it  was  again  necessary  to  apply  leeches  to  the  epigastrium. 
The  Digitalis  was  continued  until  the  20th  of  June,  when  his  general  health  having  become 
much  impaired,  I  began  to  reduce  the  dose.  He  ha.d  not,  however,  entirely  discontinued  it, 
when,  on  the  28th,  he  had  an  epileptic  seizure,  but  much  slighter  than  usual.  I  again  caused 
him  to  resume  the  full  doses  of  Digitalis,  and  he  continued  them  until  the  month  of  August, 
when  he  had  another  attack.  For  some  weeks  he  had  complained  much  of  pains  in  the 
joints,  which  always  diminished  when  the  dose  of  Digitalis  was  lessened  for  a  day  or  two, 
and  vice  versa ;  but  about  the  middle  of  August  these  gave  place  to  an  attack  of  ophthalmia, 
accompanied  by  pain  in  the  facial  nerve,  and  above  the  eye,  as  well  as  very  acute  pain  in 
the  eyeball.  Simple  treatment  failing,  I  was  obliged  to  get  him  gently  under  the  influence 
of  mercury,  since  which  it  has  entirely  disappeared.  He  has  lost  flesh  greatly  since  com- 
mencing this  plan,  and  his  general  health  is  so  much  impaired,  that,  taken  into  consideration 
together  -with  some  slight  'pectoral  symptoms,  which  have  shown  themselves  during  the 
last  few  weeks.  I  have  advised  his  father  to  abandon  all  treatment,  at  present,  for  the  cure  of 
the  epilepsy.  I  think  you  will  fully  agree  with  me,  when  you  consider  the  great  variety  of 
treatment  that  has  been  unavailingly  tried  during  so  long  a  period;  and  that  the  only  remedy 
(the  Digitalis)  which  has  really  appeared  to  control  the  attacks,  has  produced  so  much  dis- 
order of  the  general  health.  In  another  case  in  which  I  have  tried  the  same  remedy  (a 
female),  the  attacks  have  been  less  frequent,  but  have  nevertheless  returned  at  regular  in- 
tervals. I  am  satisfied  that  Digitalis  occasionally  exercises  a  *ery  decided  influence  over 
the  complaint,  and  I  think  that  it  may  prove  successful  in  a  few  instances ;  but  my  experience 
leads  me  to  think  its  administration  requires  great  caution,  and  I  should  scarcely  again  persist 


EPILEPSY.  457 

so.  long  in  its  use  as  I  have  done  in  Mr.  S.  T.  P.'s  case.     Begging  you  to  execuse  all  defects, 
as  I  write  in  haste, 

"  Believe  me,  my  dear  Sir,  very  sincerely  yours, 

"  E.  HEADLAM  GREEWHOW." 

List  of  Mr.  S.  T.  P.'s  attacks  of  epilepsy,  between  the  16th  of  November  and  12th  of  Feb- 
ruary in  each  year,  since  1841: — 

1841,  November  16th. — Two  slight  attacks;  first  at  2£  A.  M.  and  second  at  7  A.  M. ;  was 
each  time  awoke  out  of  his  sleep  by  the  aura. 

.  23d. — One  attack  at  7  A.  M.  ;  was  awoke  by  the  aura. 

29th. — Was  awoke  at  7  A.  M.  by  the  aura,  followed  by  slight  convulsion,  without  be- 
coming insensible. 

Dec.  13th. — An  attack  at  6J  A.  M.;  was  again  awoke. 

1842,  Jan.  1st. — An  attack  at  5  A.  M.;  ditto. 

Feb.  26th. — Two  attacks  whilst  asleep,  each  time  being  awoke,  as  usual,  by  the  dura; 
the  first  at  half-past  4,  and  the  second  at  half-past  7  A.  M.  ;  likewise  a  third,  in  the  waking 
condition  at  6  p.  M.  These  were  all  slight  attacks,  and  the  last  was  the  first  he  ever  had 
whilst  awake. 

Until  the  21st  of  November  1841,  the  treatment  consisted  of  bitter  tonics,  and  alterative 
doses  of  blue  pill,- with  strict  regimen,  and  the  cold  shower-bath,  and  during  the  remainder 
of  the  period  comprised  in  the  table,  of  half-grain  closes  of  Arg.  Nit.  three  times  a  day. 

Had  no  attack  between  September  the  28th  and  November  the  29th.  The  Arg.  Nit.  was 
continued  until  the  20th  of  April,  and  from  that  period,  he  took  Pulv.  Dictamni  Exotic,  and 
Pulv.  Zedoar,  as  mentioned  in  my  former  report. 

Nov.  29th. — Two  attacks,  first  at  5  A.  M.  the  second  at  6  A.  M. — -slight.  I 

Dec.  19th. — Was  awoke  at  5  A.  M.  by  the  aura,  followed  by  slight  convulsion,  but  without 
insensibility. 

1843,  Jan.  5th. — A  similar  threatening  to  the  last,  at  5  A.  M. 
17th. — Ditto,  ditto. 

Feb.  llth. — An  attack  at  6  A.  M. 

23d. — Ditto,  ditto,  at  7  A.  M. 

The  Pulv.  Dictamni,  &c.,  were  continued  until  the  20th  of  December  1842,  and  then 
abandoned.  An  issue  was  kept  open  in  the  arm  for  some  months  from  August  1842,  and 
his  diet  was  restricted  to  vegetables  and  farinacese,  from  April  until  the  commencement  of 
1843.  All  stimulants  had  been  prohibited  from  the  first. 

Nov.  1 1th. — An  attack  at  3  A.  M. 

Dec.  2d. — Ditto,  ditto,  7  A.  M. 

22d. — Ditto,  ditto,  4  A.  M.     Likewise  a  threatening,  such  as  before  described  at  7  A.  M. 

1844,  Jan.  15th. — An  attack  at  2  A.  M. 
Feb.  26th.— Ditto,  7  A.  M. 

The  issue  was  allowed  to  heal  up  in  April  or  May,  and  I  discontinued  regular  attendance 
upon  him,  although  I  always  heard  of  his  attacks.  Three  or  four  times  during  the  year 
1844  I  was  called  in  when  the  seizures  were  unusually  severe,  or  when  his  digestive  organs 
were  deranged,  but  tried  nothing  on  these  occasions,  beyond  a  little  alterative  aperient— 
Pil.  Hyd.  Pil.  Rhei.  co.  Ext.  Hyoscyami — and  occasionally  Infus.  Gentian  or  Calumbse,  with 
Garb.  Sodse,  for  two  or  three  days  at  a  time. 

1844,  Nov.  9th. — An  attack  at  7  A.  M. 
20th. — Ditto,  ditto,  at  7  A.  M. 

Dec.  17th. — Ditto,  ditto,  at  5  A.  M. 

1845,  Jan.  20th. — Ditto,  ditto,  at  5  A.  M. 
Feb.  8th. — Ditto,  ditto,  at  3  A.  M. 

I  was  only  once  consulted  by  him  between  August  1844  and  November  1845.  During 
the  whole  of  this  period,  nothing  was  done,  and  I  do  not  think  he  was  particular  in  diet,  or 
in  any  other  respect. 

1845,  Nov.  10th. — An  attack  out  of  doors,  at  9  A.  M. 
27th. — An  attack  at  10  A.  M. 

30th.— Ditto  at  12  p.  M. 
Dec.  2d. — Ditto,  at  4  A'.  M. 
9th. — Ditto,  at  4  A.  M. 

1846,  Jan.  3d.— Ditto,  at  3  A.  M. 
Feb.  2d. — Ditto,  at  6  A.  M. 
14th. — Ditto,  at  7  A.  M. 

During  this  period  he  has  been  pursuing  the  treatment  recommended  by  Mr.  Solly. 

''Tynemouth,  1st  July  1847. 
"  My  Dear  Sir— I  think  I  mentioned  that  Mr.  S.  T.  P.  had  an  attack  of  ophthalmia.     He 


458  HUMAN   BRAIN. 

has  had  several  subsequent  ones,  accompanied  by  so  much  and  such  violent  pain  in  the 
head,  that  I  at  one  time  feared  the  membranes  were  implicated.  The  last  of  these  attacks 
was  complicated  with  intractable  iritis,  which  has  resulted  in  the  destruction  of  the  right 
eye ;  since  which  his  general  health  has  been  very  much  improved,  and  although  still  sub- 
ject to  epilepsy,  the  attacks  come  on  less  regularly,  seldomer,  and  with  less  severity  than 
formerly.  It  is  not  now  uncommon  for  him  to  have  all  the  sensations  of  an  attack  without 
losing  his  recollection.  From  circumstances  which  have  since  come  to  my  knowledge,  I 
am  disposed  to  believe,  that  had  the  patient,  in  this  instance,  followed  implicitly  my  instruc- 
tions as  to  regimen,  the  case  would  have  terminated  more  satisfactorily.  I  have  advised  a 
trial  of  the  Digitalis  in  several  cases  since  Mr.  S.  T.  P.'s,  but  have  not  personally  superin- 
tended the  treatment,  nor  found  it  exercise  the  same  decided  influence  which  it  did  in  that 
instance.  I  believe  a  young  lady  at  Cambridge,  for  whom  I  have  been  several  times  consult- 
ed, is  now  trying  it,  but  I  have  not  as  yet  heard  the  result. 

"  Believe  me,  my  dear  Sir,  yours  very  sincerely, 

"  E.  HEADLAM  GHEENHOW." 

I  will  next  relate  briefly  some  of  the  cases  in  which  I  have  seen  the 
oxyde  of  silver  useful.  The  first  was  in  the  person  of  a  remarkably  fine 
young  man,  about  twenty  years  of  age,  full  habit  of  body.  The  disease 
appears  to  have  been  induced  in  him  by  a  change  from  an  abstemious 
mode  of  living,  pursued  when  abroad,  to  the  full  diet  and  rich  wines 
found  at  the  tables  of  the  wealthy  in  this  country.  The  first  attack  oc- 
curred in  the  day-time  after  a  ball  the  night  before,  no  bed,  and  strong 
ale  for  breakfast;  it  was  ushered  in  with  strong  symptoms  of  inflamma- 
tion of  the  brain,  and  treated  accordingly.  He  suffered  from  the  disease 
for  fifteen  years,  with  varying  severity ;  the  longest  interval  during  the 
whole  of  that  time  was  three  months,  but  this  only  occurred  once  ;  the 
usual  interval  was  two  months,  and  then  fourteen  days;  the  number  of 
fits  at  each  period  varied  from  four  or  five  up  to  twenty  ;  on  one  occasion 
he  had  a  fit  every  two  hours  as  the  clock  struck,  for  forty-eight  hours. 
He  told  me  that  he  had  sometimes  averted  a  fit  by  taking  a  deep  inspi- 
ration. I  asked  him  how  he  knew  he  was  going  to  have  a  fit;  he  said 
by  uneasy  sensations  about  his  chest  and  singing  in  his  ears.  And 
these  warnings  of  approaching  attacks  have  frequently  enabled  him  to 
leave  the  room  where  he  was  sitting,  before  the  attack  came  on.  He 
mentioned  to  me  that  on  one  occasion  after  a  series  of  attacks,  on  being 
addressed  by  any  one,  the  observation  addressed,  instead  of  conveying 
the  idea  that  was  meant,  gave  rise  to  some  other  idea.  Some  time  after 
the  attacks  he  suffered  dreadfully  from  spasmodic  action  of  the  respira- 
tory muscles,  the  spasms  recurring  at  about  three  or  five  minutes,  giving 
rise  to  a  sense  of  choking,  which,  after  continuing  for  about  three  hours 
was  followed  by  violent  pain  in  the  region  of  the  heart ;  this  was  relieved 
by  the  following  draught; — 

Tinct.  Hyoscyami.  gj.  Ant.  Pot.  Tart.  gr.  ss.  Magn.  Sulph  gij.  Mist.  Camph.  %j. 

When  the  series  of  attacks  were  passing  off,  he  usually  had  one  or 
two  half  attacks ;  that  is,  he  would  be  in  a  state  of  insensibility  for  a 
minute  or  two,  but  there  would  be  no  cry  or  convulsions.  The  mind 
was  more  affected  by  these  than  the  complete  attacks.  There  was  no 
headache  before  the  attacks,  but  more  or  less  headache  afterwards;  when 
several  occurred,  then  the  pain  would  be  violent.  The  memory  was 
much  affected,  the  intelligence  blunted,  the  temper  irritable.  Every 
plan  of  treatment  was  tried  and  every  medicine  given  ;  he  travelled 
abroad  with  a  medical  man  ;  he  tried  homeopathy  for  two  years ;  he 


EPILEPSY.  459 

tried  mesmerism  ;  but  one  of  the  most  celebrated  professors  of  this  art 
declared  his  case  unfit  for  it — incurable. 

During  the  greater  part  of  his  illness  he  was  on  a  farinaceous  diet, 
meat  diet  invariably  making  him  too  plethoric  ;  on  the  farinaceous  diet 
his  strength  was  immense,  and  he  could  walk  from  fifteen  to  twenty 
miles  a-day  with  ease.  He  commenced  taking  the  oxyde  of  silver  in 
the  month  of  October,  shortly  after  having  had  five  attacks  at  the  usual 
interval  of  eight  weeks ;  at  the  end  of  the  next  fortnight  he  had  one 
slight  attack,  and  he  has  never  had  another.  The  dose  was  one  grain 
three  times  a-day,  continued  for  two  months,  and  then  omitted  for  a 
fortnight,  the  conjunctiva  being  carefully  watched,  to  observe  any  change 
of  color.  In  addition  to  the  oxyde  of  silver,  he  occasionally  had  the 
tenth  of  a  grain  of  calomel  with  each  pill,  and  also  the  following 
draught : — 

Liq.  Potass,  ^iss.  Tinct.  lodin.  co.  ^j.  Spirit  JEth.  Nit  Sjiss.  M.  capiat  cochl.  min.  j.  bis 
in  die  ex  cyatho  parvo  aquae. 

The  compound  colocynth  pill  occasionally  at  night,  if  the  bowels  were 
at  all  confined.  The  silver  was  continued,  with  the  intervals  of  four- 
teen days,  for  twelve  months.  He  has  now  been  well  nearly  four  years, 
and  has  quite  recovered  his  mental  activity.  He  has  been  closely  occu- 
pied in  a  public  office,  and  has  gone  through  a  good  deal  of  anxiety  ; 
he  has  returned  to  a  meat  diet,  but  not  to  the  use  of  stimulants;  he  is 
strong  and  well,  but  cannot  take  so  much  exercise  as  he  could  when 
suffering  from  the  disease,  and  he  does  not  feel  the  want  of  it  so  as  to 
produce  strong  perspirations,  which  he  then  found  much  relief  from. 

The  next  case  I  give  briefly  in  my  patient's  own  words : — 

Case  91. — "My  first  attack  of  epilepsy  was  when  I  was  about  eleven  years  old:  I  was 
bled  at  the  time,  and  when  I  recovered  my  strength  I  was  not  put  on  any  particular  diet,  or 
under  any  course  of  medicine. 

"  I  had  no  return  until  I  was  nearly  fifteen,  although  I  had  frequently  felt  symptoms  of 
epilepsy. 

"In  the  beginning  of  June,  1838,  I  had  an  attack.  I  was  put  on  very  strict  diet,  by  the 
advice  of  Sir  Benjamin  Brodie — 4  oz  of  meat,  6  oz.  of  bread.  My  attacks  continued,  on  an 
average,  about  every  five  weeks,  for  two  years;  during  which  time  I  abstained  from  beer, 
wine,  and  spirits,  but  did  not  rigidly  adhere  to  the  diet  recommended  by  Brodie. 

"  At  the  age  of  seventeen,  I  took  for  a  year  powdered  tin,  given  me  by  a  lady,  and  had  a 
cessation  of  attacks  for  nine  months,  but  during  that  time  I  certainly  often  felt  symptoms  of 
an  attack.  I  discontinued  the  tin,  on  a  return  of  my  old  complaint,  21st  Jan.  1841.  On  the 
27th  April  of  the  same  year  I  had  an  attack  ;  again,  July  24th;  and  on  the  5th  October.  I 
observed  no  particular  diet,  but  took  beer  and  wine  in  small  quantities. 

"On  23d  October  1841,  I  left  England,  and  had  no  attack  until  May  1842  ;  again  in  Oc- 
tober 1 842 ;  and  during  my  stay  in  the  colony,  I  had  them  about  once  every  three  months. 
Had  an  attack  5th  of  July  (the  day  I  landed),  and  on  the  13th  of  August. 

"  1844.— I  consulted  Mr.  Solly  for  the  first  time  on  the  8th  of  July,  and  since  the  13th  of 
August  1844  have  had  none  of  the  feelings  which  I  considered  attacks  or  warnings  of  an 
attack." 

Treatment. — Began  Argent.  Oxyd.  gr.  j.  t.  d.,  July  8th,  1844;  July  5th,  an  attack;  one  on 
13th  August.  Argent.  Oxyd.  gr.  xxij.  Hyd.  Chlorid.  gr.  iij.  in  Pil.  xij.  Sumat.  j.  t.  d. 

September  16th. — Pil.  Rhei  co.  gr.  vij.  Cal.  gr.  ij.  h.  n.  Hs.  mane. 

October  6th. — Added  Ext.  Col.  co.  gr.  v.  ad.  gr.  j  Lingul. 

November  8th. — To  discontinue  silver,  having  taken  it  four  months;  has  had  no  attack 
since  August  13th. 

January  12th,  1 845. — Has  had  no  symptoms  whatever  of  an  attack ;  returned  to  the  use 
of  the  silver  in  this  form.  R.  Argent.  Oxyd.  gr.  xxiv.  Ext.  Col.  co.  ^j.  Cal.  gr.  ij.  Conf.  Q. 
8.  fiat  Pil.  xx. 

April  9th. — To  leave  off  Argent.  Oxyd.,  and  take  a  purgative;  feels  quite  free  from  all 
symptoms. 


460  HUMAN   BRAIN. 

18th. — Weak;  loss  of  appetite;  to  take  Quinine  and  Ferri  Sulphas,  gr.  j.  t.  d. 
June  24th. — Feeling  perfectly  well,  he  discontinues  these  pills  in  about  a  week. 
June  1847. — Continues  perfectly  well,  and  is  now  living  in  South  America. 

In  the  next  case  the  fits  disappeared  under  the  use  of  the  oxyde  of 
silver. 

Case  92. — Miss  S ,  aet.  30,  of  fresh  complexion,  had  suffered  from  epilepsy  for  six 

years.  It  came  on  after  the  subsidence  of  an  attack  of  rheumatic  gout;  her  general  health 
is  good,  and  she  menstruates  regularly,  but  suffers  a  good  deal  of  pain  during  that  period; 
she  has  no  leucorrhoea  or  headache  either  before  or  after ;  her  memory  is  not  at  all  affected, 
and  she  has  no  warning  when  an  attack  is  coming  on ;  she  used  to  grind  her  teeth  in  sleep, 
but  does  not  do  so  now ;  she  has  had  three  attacks  in  the  last  eight  weeks,  but  previous  to 
that  had  an  interval  of  six  months;  a  fit  does  not  last  more  than  eight  or  ten  minutes,  and 
they  are  shorter  in  duration  than  they  used  to  be,  and  less  violent ;  they  recur  more  frequently 
in  the  night  than  day ;  the  last  happened  last  Sunday,  when  she  was  at  chapel. 

On  the  27th  of  September  1844,  Miss  S applied  to  me  for  medical  treatment,  she 

suffering  at  the  time  from  attacks  of  epilepsy.  I  ordered  her  to  take  R.  Argent.  Oxyd.  gr.  j. 
Conf.  28,  ut  fiat  Pilula,  b.  d. 

Oct.  28th. — Her  medicine  was  altered  to  Pil.  cap.  ter  in  die. 

Dec.  19th. — Has  continued  the  medicine  regularly  up  to  this  time,  but  had  an  attack  be- 
tween twelve  and  one  o'clock  on  the  5th  inst.,  and  also  on  the  13th  in  the  morning  about 
seven ;  she  was  ordered  to  leave  off  the  Pil.  for  a  fortnight,  and  take  &.  Liq.  Potassse  ^iss. 
Tinct.  Iodine  co.  gj.  Sp.  ^Ether  Nit.  ^j.  mist,  cujus  sumat.  coch.  min.  et  cyatho  vinoso  aquae 
bis  in  die. 

Jan.  2d,  1845. — She  was  not  better,  and  the  Oxyd.  of  silver  was  recommended. 

Feb.  20. — The  patient  has  continued  to  take  her  Pil.  ever  since  the  last  date,  but  not  quite 
regularly  during  the  last  fortnight.  Ordered  to  continue  them  b.  d. ;  she  has  suffered  lately 
from  slight  palpitations  of  the  heart. 

April  19th. — She  has  had  one  slight  attack  in  the  night.  Ordered  to  continue  the  medicine 
as  before. 

May  5th. — Much  the  same ;  to  take  her  Oxyd.  three  times  a-day. 

6th. — She  had  another  slight  attack  in  the  night,  but  it  only  lasted  a  very  short  time. 

13th. — Has  had  a  half  attack. 

27th. — To  continue  the  medicine  as  before,  three  times  a-day;  has  had  no  further  attack. 

28th. — The  patient  had  an  attack  in  the  night. 

June  6th. — There  has  been  no  fit  since  the  last  date ;  she  was  ordered  to  leave  off  the 
Oxyd.,  having  taken  it  for  five  months  fourteen  days,  and  ordered  to  resume  the  mixture  of 
Liq.  Potassse,  &c.,  instead. 

July  5th. — Has  had  a  very  slight  attack  in  the  night;  the  medicine  to  be  continued. 

Aug.  13th. — She  has  had  no  further  attack;  the  Oxyd.  to  be  resumed. 

Sep.  24th. — Has  continued  the  pills  six  weeks,  and  has  remained  quite  well;  she  is  much 
distended  in  the  stomach. 

Oct.  15th. — Ordered  to  leave  off  the  Argent.  Oxyd.,  there  being  some  slight  appearance  of 
blue  upon  the  conjunctiva. 

22d. — She  has  had  a  very  slight  attack  this  morning,  which  lasted  a  few  minutes,  and  she 
has  since  slept  for  two  hours;  a  very  short  time  after  she  was  enabled  to  resume  her  em- 
ployment of  drawing.  She  says  she  feels  much  better  than  she  usually  does  after  an  attack. 

25th. — Ordered  to  resume  the  Oxyd.,  though  the  conjunctiva  has  quite  a  blue  tint. 

June  23d,  1847. — She  has  had  continued  health  up  to  this  time,  having  had  no  attack 
since  April  1846. 

In  the  next  case  the  Oxyd.  of  silver  exhibited  great  power  over  the 
fits ;  but  I  was  obliged  to  abandon  it  in  consequence  of  its  tinging  the 
skin. 

Co.se  93. — April  13th,  1846. — Jane  Brown,  set.  24,  single,  healthy  looking, — her  counte- 
nance not  at  all  indicating  any  cerebral  disease, — states  she  has  been  subject  to  fits  of  an  epi- 
leptic character  ever  since  she  was  nine  months  old ;  they  then  attacked  her ;  sometimes 
there  was  an  interval  of  nine  or  even  twelve  months  between :  they  continued  to  attack  her, 
with  these  long  intervals,  till  about  seventeen  or  eighteen;  they  then  came  on  much  more 
frequently,  sometimes  only  a  fortnight,  and  at  other  times  there  has  been  too  and  three 
months'  interval.  The  longer  she  goes  without  the  fits,  the  worse  she  is  when  they  do 
attack  her.  She  has  them  now  less  frequently;  her  last  attack  was  about  three  weeks  ago; 
ami  when,  after  the  weakness  and  general  debility  occasioned  by  the  fits  have  passed  off, 


EPILEPSY.  461 

and  her  health  and  strength  are  returning,  she  is  again  attacked.  The  fits  are  of  a  strong  con- 
vulsive character,  and  last,  with  the  intervals,  three  or  four  days,  then,  as  before-mentioned, 
leave  her  weak  and  debilitated.  She  is  regular ;  bowels  in  good  order ;  and  says  if  she 
could  get  rid  of  the  fits  she  should  soon  get  strong  and  well ;  has  not  been  able  to  go  to  ser- 
vice on  account  of  them.  Ordered — Argent.  Oxyd.  Pulv.  Acaciae  gr.  j.  ft.  Pil.  xviij.  t.  d.  Nit.  t. 
Cal.  co.  gr.  v.  h.  s.  Si  alocis  constipe  t.  d. 

May  6th. — Has  continued  well;  to  continue  the  medicine. 

26th. — She  states  that  she  is  better  this  week,  but  that  last  week  she  had  a  pain  in  her 
chest,  pointing  to  her  stomach,  and  that  this  pain  has  usually  preceded  a  fit,  but  that  on  this 
occasion  it  did  not  do  so ;  continue  the  medicine. 

28th. — She  has  not  had  any  fit  since  she  first  consulted  me ;  but  her  mother  says  she  is 
now  in  fear  of  one  coming  on ;  because  she  has  noticed  that  they  are  preceded  by  pain  and 
soreness  in  her  stomach  and  all  across  her  body.  No  pain  in  her  head.  Her  health  in  other 
respects  is  tolerably  good.  She  has  continued  the  pills  regularly  from  the  13th  of  April. 
Argent.  Oxyd.  Pulv.  Acid.  a.  gr.  j.  Ext.  Cal.  co.  gr.  j.  Theriag.  Q.  S.  ut  fiat  Pil  j.  ter  in  die 
sum.;  bowels  regular. 

July  9th. — Has  not  had  any  fits  since  she  consulted  me ;  has  taken  Oxyd.  three  months. 
Ordered  to  discontinue  it  for  a  week. 

23d. — Has  not  taken  the  medicine  for  fourteen  days.  On  Sunday,  the  19th,  she  experienced 
very  uncomfortable  feelings  in  the  stomach,  as  if  she  was  going  to  have  a  fit,  but  she  did  not 
lose  her  senses.  She  cannot  describe  the  feelings,  but  she  says  they  did  not  rise  to  the  head 
as  they  do  when  they  terminate  in  a  fit.  She  had  had  some  fresh  currant  pudding  with  her 
dinner. 

She  took  some  castor  oil  on  the  Monday  about  four  or  five  o'clock,  and  after  that  began  to 
act,  she  began  to  feel  better,  and  is  now  feeling  nearly  well  again,  but  not  quite.  Pulse  22, 
irritable.  Ordered  to  resume  the  Argent.  Oxyd.  and  to  take  Nit.  Cal.  co.  if  these  feelings 
should  recur. 

August  19th. — Has  been,  on  the  whole,  feeling  well;  but  last  Saturday  and  Sunday  she 
felt  pain  in  her  stomach,  and  an  uncomfortable  faint  feeling;  but  this  passed  off,  and  she  has 
now  a  slight  pain  in  her  stomach.  Ordered  Bismuth  Tris.  Nit.  gr.  iv.  t.  d. 

Sept.  22. — Has  been  taking  the  Bismuth  since  the  19th  ultimo.  She  was  not  so  well  about 
the  17th  or  18th  of  this  month;  but  they  did  not  communicate  with  me. 

She  had  a  fit  on  the  20th.     Ordered  to  renew  the  Argent.  Oxyd. 

Oct.  15th. — Has  continued  well  and  more  free  from  pain;  a  little  dark  under  the  eyes. 
To  leave  off  for  a  week. 

22d. — Says  that  for  the  first  three  days  after  leaving  off  the  medicine,  her  stomach  was 
uncomfortable  ;  but  that  after  taking  an  aperient  pill  it  became  all  right.  Ordered  to  renew  the 
medicine. 

Nov.  19th. — Feels  well;  no  pain  in  the  head;  stomach  comfortable;  sometimes  a  little 
pain,  but  not  much.  Continue  the  medicine. 

Dec.  2d. — No  fit,  but  was  very  uncomfortable  two  days  ago,  as  if  she  was  going  to  have 
one,  but  it  passed  off,  and  she  now  feels  pretty  well.  Ordered  to  continue  the  Argent.  Oxyd. 

1847,  Jan.  4th. — Has  had  no  more  fits  since  the  last  report;  looks  very  blue  under  the 
eyes,  but  not  elsewhere.  Leave  off  Oxyd.,  take  Creosote. 

12th. — The  appearance  of  blueness  has  not  increased;  thinks  that  she  has  had  more  pain 
in  her  stomach  lately,  and  some  feeling  of  the  fits.  Ordered  Bismuth  gr.  ij.  t.  d. 

March  15th. — Decidedly  blue  under  the  eyes;  a  blue  line  on  the  gurns  of  the  lower  jaw; 
had  a  slight  fit  on  March  9th,  during  the  menstruation  period ;  interval  nearly  six  months  ; 
the  last  on  the  22d  of  Sept.  Ordered  Zinci  Sulph.  gr.  ij.  t.  d. 

31st. — Bismuth  Nit.  gr.  iv.  t.  d.  A  severe  fit  yesterday  ;  has  been  quite  regular;  it  is  now 
about  the  monthly  period. 

April  13th. — Much  the  same;  slight  uncomfortable  feeling  about  the  stomach.  Creosote 
TT\j.  b.  d. 

May  1st. — Had  two  fits  just  previous  to  the  monthly  period ;  the  flow  followed  a  day  or 
two  after;  she  had  several  half  attacks,  but  not  coming  quite  to  a  struggle. 

10th. — Had  taken  no  medicine  since. 

17th. — She  is  decidedly,  though  slightly,  tinged  with  the  Argent. ;  it  is  manifest  below  the 
eyes,  and  it  forms  a  dark  line  on  the  edge  of  the  gums ;  she  has  not  had  any  return  of  the 
fits.  As  the  last  attack  occurred  just  before  the  monthly  period,  I  have  ordered  Ferri  Sulph. 
gr.  j.  Zinci  Sulph.  gr.  j.  b.  d.  Nit.  Aloes  c.  Myrrh  gr.  v.  o.  n. 

I  have  found  the  shower-bath  decidedly  beneficial  in  epilepsy,  and  I 
am  glad  to  find  Dr.  Watson  giving  his  testimony  strongly  in  its  favor. 
He  states  that  he  has  found  more  good  from  the  vinum  ferri  than  other 

-tH»    V  « 


462  HUMAN    BRAIN. 

tonics.  He  enjoins  total  abstinence  from  stimulating  liquors,  and  then 
goes  on  to  recommend  the  olii  terebinth.  He  says,*  "  You  will  find 
that  most  persons,  in  respect  to  that  disease  we  are  now  considering, 
have  some  favorite  or  usual  mode  of  treatment ;  and  if  I  were  called 
upon  to  name  any  single  drug  from  which,  in  ordinary  cases  of  epilepsy, 
I  should  most  hope  for  relief,  I  should  say  it  was  the  oil  of  turpentine. 
And  I  find  that  other  persons  have  come  to  the  same  conclusion.  Dr. 
Latham,  the  elder,  was,  I  believe,  the  first  person  that  made  known  its 
efficacy  in  this  disorder.  Foville  states  that  he  has  seen  excellent  effects 
from  it.  It  is  highly  spoken  of  by  Dr.  Percival  in  the  Dublin  Hospital 
reports.  It  is  not  given  in  large  doses,  but  in  small  ones,  frequently 
repeated;  from  half  a  drachm  to  a  drachm  every  six  hours.  You  are 
aware  that  it  sometimes  produces  strangury,  and,  therefore,  the  patient 
must  be  forewarned  of  this  or  carefully  watched.  Occasionally  turpen- 
tine has  done  good  in  virtue  of  its  anthelmintic  properties.  I  know  that 
a  physician  of  my  acquaintance  cured  a  case  of  epilepsy  in  this  way 
somewhat  to  his  own  surprise.  Without  having  in  his  mind  any  notion 
of  worms,  he  thought  it  might  be  as  well  to  purge  his  patient,  who  had 
labored  for  some  time  under  epilepsy,  with  the  oleum  terebinthinaB.  The 
patient,  who  was  the  brother  of  a  person  holding  at  present  high  office 
in  this  country,  was  residing  some  miles  out  of  town.  In  the  middle  of 
the  night  the  doctor  was  summoned  to  him  in  a  great  hurry;  the  mes- 
senger said  he  was  supposed  to  be  dying.  He  was  only  intoxicated, 
however,  by  the  free  dose  of  turpentine  he  had  taken.  The  next  morn- 
ing he  passed  into  the  close-stool  a  large  tape  worm  ;  he  has  never  had 
epilepsy  since.  The  late  Lord  Hardwicke,  father  of  the  present  Earl, 
had  epilepsy,  and  he,  too,  got  rid  of  his  epilepsy,  and  of  a  worm  at  the 
same  time.  I  believe  that  the  cure  was  effected  by  turpentine,  but  I 
am  not  certain  of  that.  Such  cases  are  remarkably  interesting;  they 
show  that  irritation  of  the  stomach  or  intestines  may  be  sufficient  to 
cause  the  fit;  they  illustrate  exellently  well  the  eccentric  form  of  the 
disease,  and  they  deserve  always  to  be  borne  in  mind  when  we  are  asked 
to  prescribe  for  an  epileptic  patient.  A  cure  from  so  dreaded  a  com- 
plaint by  such  simple  means,  the  cause  of  his  malady,  and  the  certainty 
of  his  having  got  rid  of  that  cause,  being  botn  so  obvious  to  the  patient, 
may  be  enough  sometimes  to  make  a  practitioner's  fortune.  But  I  think 
you  will  sometimes  find  the  oil  of  turpentine  very  useful,  even  though 
it  expels  no  worm,  and  there  is  no  worm  to  expel:  if  the  bowels  should 
be  costive,  the  oil  of  turpentine  and  castor  oil  go  exceedingly  well 
together." 

I  have  not  employed  the  turpentine,  but  I  am  not  unfrequently  con- 
sulted by  patients  to  whom  it  has  been  unsuccessfully  administered. 
In  the  following  instance  it  had  been  given  very  freely  by  a  very  intel- 
ligent physician,  but  without  any  apparent  benefit.  The  account  of  the 
case  is  in  the  husband's  own  words: — 

Case  94. — "  Mrs.  P.  S.  for  the  last  six  years  has  been  subject  to  violent  sensations,  which 
deprives  her  of  all  power  of  speech,  though  sensible  of  all  that  passes;  they  last  for  about 
two  minutes ;  the  muscles  of  the  face  are  contracted,  and  a  slight  grinding  of  the  teeth. 
But  within  the  last  two  years,  when  the  sensations  have  come  on,  and  she  has  been  asleep, 
she  has  gone  from  one  of  them  into  a  true  epileptic  fit,  which  has  shaken  her  very  much ; 

*  Medical  Gazette,  vol.  xxviii.  p.  376. 


ORGANIC    DISEASES    OF   THE   BRAIN.  463 

and  for  an  hour  after  could  hardly  keep  her  from  fainting;  complaining  of  cramp  in  the 
calves  of  her  legs,  and  violent  pain  in  the  head,  and  sickness;  have  generally  given  her  a 
little  sal  volatile  in  water;  she  had  one  on  Nov.  the  9th,  and  again  on  Dec.  21st.  The  sen- 
sation came  on  again  on  Feb.  2,  (but  no  fit,)  they  were  stronger  then  than  when  she  has 
had  a  fit.  Mr.  T.,  her  usual  medical  attendant,  cupped  her  about  a  year-and  a-half  ago  ;  but 
not  more  than  a  wineglass  of  blood  carne  away;  and  felt  very  faint.  The  bowels  in 
general  very  costive,  and  troubled  with  much  wind  at  the  chest;  likewise  troubled  with  a 
violent  irritation  at  the  rectum." 

Remarks — Aged  45  years;  had  13  children;  violent  flooding  after  the  birth  of  each  child; 
had  several  miscarriages ;  complains  of  great  heat  on  the  top  of  the  head  and  over  the  eyes  ; 
youngest  child  twelve  last  July ;  two  miscarriages  since ;  the  last  is  about  ten  years ;  it  is 
five  months  since  she  had  any  show. 

March  6th,  1847.— Pulse  16;  dose  £ij.  h. 

7th.— Pulse  14,  18.  giij. 

8th. — Pulse  14,  at  eight  in  the  morning,  16,  at  half-past  eleven.  She  says  that  after  taking 
the  medicine  last  night  she  felt  very  faint.  Her  husband,,who  felt  her  pulse,  says  that  it  was 
15  and  16  in  the  quarter ;  but  irregular  in  force  and  frequency,  and  slightly  intermittent. 
She  says  she  felt  very  much  as  she  has  felt  after  a  violent  flooding.  If  she  attempted  to 
raise  herself  in  bed  she  felt  a  numbness  all  over.  She  did  not  feel  unusually  cold,  though  she 
suffers  generally  a  good  deal  in  that  respect. 

9th. — To  leave  otf  the  Digitalis  and  take  Zinci  Sulph.  gr.  ij.  b.  d.  Nit.  Purgans  o.  n. 

16th. — Leave  off  the  Zinci,  and  take  Argent.  Oxyd.  gr.  j.  ter  in  die.  Liq.  Magn.  Inf.  Rhei 
ijss.  Tinct.  Aloes  co.  gij.  Tinct.  Card.  co.  gj.  o.  n. 

20th. — One  fit.     Loss  of  limbs  for  above  an  hour. 

23d. — Continue  the  medicine. 

April  14th. — Argent.  Oxyd.  gr.  j.     Hydr.  c.  Creta  gr.  ss.  ter  in  die. 

May  10th. — Has  been  taking  warm-baths  twice  a-week;  has  been  more  comfortable 
since. 

Last  Thursday  week,  April  30th,  complete  attacks,  and  several  slight  ones. 

Pulse  18.     Looks  decidedly  better — more  cheerful. 

31st. — Has  continued  the  warm  baths  three  times  a-week;  is  wonderfully  improved  in 
appearance ;  looks  cheerful,  and  countenance  not  so  pale ;  has  continued  the  Argent.  Oxyd. 
gr.  j.  bis  in  die.  No  fit  of  any  kind.  Says  she  is  much  better. 

"June  11,  1847. 

"  My  dear  Sir, — I  am  in  hopes  there  is  an  improvement  in  Mrs.  P.  S. ;  she  has  not  had  a 
fit  at  present,  and  not  more  than  three  of  the  sensations;  but  still  there  seems  something 
lurking  about  her;  at  night  she  is  very  restless,  and  complains  of  feeling  very  faint;  whether 
there  is  anything  in  the  mixture  or  not,  that  causes  it,  I  cannot  tell,  but  will  call  upon  you  on 
Monday." 

June  16th. — Says  she  has  less  of  the  sensations,  arid  that  they  now  pass  off  with  a  slight 
perspiration  about  the  eyelids.  Still  troubled  with  a  feeling  of  wind  in  the  stomach.  Or- 
dered Bismuth  gr.  v.  Ext.  humuli  gr.  iv.  Not  more  than  five  semi-attacks  in  a  week ;  very 
slight  struggle;  not  insensible  for  more  than  a  minute  and  a  half;  they  used  to  occur  seven 
or  eight  in  the  day. 

July  3d. — Feels  altogether  much  better ;  does  not  suffer  so  much  from  the  faintness ;  has 
left  off  the  warm  baths,  but  has  continued  the  Bismuth.  Bowels  act  more  comfortably,  as 
she  has  taken  more  exercise.  Pulse  21,  20.  Tongue  clean;  does  not  sleep  altogether  well 
at  night ;  wakes  about  one,  and  kicks  about,  stretches,  moans,  but  has  no  headache.  Argent. 
Oxyd.  gr.  j.  Opii.  gr.  f .  Ext.  Col.  co.  gr.  iij.  M.  pil.  ter  in  die  sum. 

Organic  Diseases  of  the  Brain. — By  organic  diseases  of  the  brain,  I 
mean  all  those  morbid  growths  from  the  neurine  of  the  encephalon  or  its 
membranes,  which  are  not  the  result  of  simple  hypersemia  of  these  struc- 
tures. These  may  be  divided  into  malignant  or  non-malignant,  accord- 
ing to  the  sense  in  which  these  terms  are  generally  employed  in  speaking 
of  morbid  growths  in  other  organs  ;  though  we  all  know  too  well  that 
all  morbid  growths  within  the  skull  are  almost  always  sooner  or  later 
fatal,  and  thus  equally  malignant. 

The  consideration  of  these  tumors  is  extremely  unsatisfactory  both  in 
a  therapeutical  and  physical  point  of  view.  In  other  regions  all  tumors 
are  highly  interesting  to  the  surgeon,  both  medically  and  chirurgically; 


464  HUMAN   BRAIN. 

but  here  he  feels  that  medicine  and  local  applications  have  but  little 
power,  and  that  the  knife  is  of  no  use. 

Regarding  the  treatment  of  these  tumors,  there  is  not  much  to  be  said, 
though  I  agree  with  Dr.  Abercrombie  that  we  should  not  consider  them 
all  as  hopeless.  The  system  must  be  kept  rather  low,  but  not  so  as  to 
impair  the  general  health.  Mercury  must  be  employed,  but  in  such  doses 
that  the  use  of  it  may  be  continued  for  many  months.  The  iodide  of 
mercury  is  of  great  value  in  these  cases  if  it  does  not  disturb  the  general 
health. 

In  a  physiological  point  the  innumerable  histories  of  these  cases  are 
valueless,  from  the  want  of  accuracy  in  their  detail  and  the  impossibility 
of  ascertaining  the  limits  to  which  the  influence  of  any  tumor  within 
the  skull  may  be  excited.  I  shall  therefore  confine  myself  to  a  very  brief 
outline  of  this  division  of  our  subject.  Under  the  head  of  organic  dis- 
eases of  the  brain  are  included  those  of  the  membranes  also.  The  first 
of  these  that  we  have  to  consider  are  sometimes  peculiarly  interesting 
to  the  surgeon;  I  allude  to  those  tumors  of  the  dura  mater  which,  per- 
forating the  skull,  make  their  way  outwards.  Such  is  not  often  the  pro- 
gress of  cerebral  tumors,  but  there  are  several  on  record.  Dr.  Aber- 
crombie refers  to  them  in  the  following  words:* — u  Tumors  of  this  kind 
sometimes  arise  from  the  external  surface  of  the  dura  mater ;  in  this 
case  they  have  been  frequently  known  to  produce  absorption  of  the  bone, 
and  to  rise  externally  under  the  integuments  of  the  head,  so  as  to  be 
mistaken  for  wens.  Many  cases  of  this  kind  are  mentioned  by  the 
French  writers.  In  some  of  them  the  disease  seems  to  have  been  origi- 
nally excited  by  injuries:  and  in  others  an  injury  appears  to  have 
accelerated  the  process  by  which  the  tumor  was  making  its  way  through 
the  bone.  When  these  tumors  have  been  rashly  meddled  with  by  inci- 
sion, death  has  generally  been  the  consequence."  The  surgeon  is  often 
required  to  decide  on  the  nature  of  tumors  on  the  head  both  as  regards 
diagnosis,  prognosis,  the  propriety  of  operative  interference,  and  other 
plans  of  treatment. 

M.  Louis,  who  was  Royal  Professor  of  Physiology,  senior  Surgeon  to 
the  Hospital  de  la  Charite,  and  perpetual  Secretary  of  the  Royal  Aca- 
demy of  Surgeons,  Paris,  was  one  of  the  first  who  pointed  out'  the 
nature  of  the  penetrating  tumors  of  the  dura  mater.  His  paper  is  pub- 
lished in  the  thirteenth  volume  of  the  Memoirs  de  PAcademie  Roy.  de 
Chirurg.,  1784.  He  states  that  the  profession  mistook  the  nature  of  these 
tumors,  because  they  could  not  believe  that  a  soft  substance,  such  as 
these  tumors,  could  penetrate  a  hard  substance  like  the  bones  of  the 
skull.  "  But,"  says  he,  "  does  not  nature  show  us  similar  phenomena 
in  the  human  body  ?  have  we  not  seen  aneurism  of  the  arch  of  the  aorta 
find  its  way  through  the  substance  of  the  sternum  ?"  He  relates  twenty 
very  interesting  cases  in  a  very  graphic  manner ;  most  of  them  are  not 
the  result  of  his  own  observation,  but  collected  from  various  sources  ; 
some  are  accompanied  with  drawings.  The  whole  paper  is  worthy  of 
perusal.  In  the  first  case  the  patient  fell  heavily  on  his  buttocks,  with- 
out striking  his  head,  but  still  he  felt  it  was  disturbed  by  'the  accident, 

*  Abercrombie,  p.  313,  op.  cit. 


ORGANIC    DISEASES    OP    THE    BRAIN.  465 

and  he  had  great  difficulty  in  rising.  The  accident  was  not  accom- 
panied with  any  pain  ;  but  the  disturbance  of  the  dura  mater  appeared 
to  last  for  four  months,  and  then  insensibly  disappeared.  After  a  per- 
fectly quiet  interval  of  four  months,  or  thereabout,  one  morning  when 
his  barber  was  shaving  his  head  he  perceived  a  singular  sound  elicited 
by  the  razor,  like  the  crackling  of  dry  parchment.  The  barber  remarked 
it  to  his  customer,  who  tapping  his  head  at  the  same  spot  also  perceived 
it.  At  this  time  there  was  neither  depression  nor  elevation.  On  the  fol- 
lowing day  a  small  tumor  appeared  about  the  size  of  half-a-crown,  a  little 
raised,  and  with  a  pulsatory  movement.  The  tumor  increased  slowly, 
and  the  first  opinion  which  he  obtained  regarding  its  nature  was,  that  it 
was  an  aneurism  ;  a  bandage  was  ordered,  but  he  could  not  bear  the 
pressure,  which  easily  made  it  disappear,  but  gave  rise  to  such  giddi- 
ness that  it  frightened  him.  He  was  seen  by  a  great  number  of  sur- 
geons ;  some  of  them  adhered  to  the  idea  of  its  being  an  aneurism  ; 
others  thought  it  was  a  hernia  of  the  brain  ;  but  "  the  greater  number," 
says  Louis,  u  suspended  their  judgment,  not  wishing  to  expose  it  on  a 
disease  that  they  regarded  as  an  extraordinary  affair."  It  increased  to 
the  size  of  a  turkey's  egg,  having  the  singular  peculiarity,  that  pressure 
on  it  removed  the  pain,  which  Louis  accounts  for  by  supposing  that  the 
pain  was  occasioned  by  the  pricking  of  the  sharp  points  of  bone  from 
the  edge  of  the  opening  in  the  skull.  But  as  loss  of  consciousness  was 
the  effect  of  the  pressure,  he  preferred  the  pain  to  the  remedy.  He  died 
on  the  17th  of  April,  1763,  about  two  years  and  four  months  from  the 
time  of  the  accident. 

The  tumor  was  not  even  adherent  to  the  skin  ;  he  simply  says  that 
the  tumor  was  covered  by  a  distinct  membrane,  and  of  the  same  con- 
sistence as  the  ordinary  sarcomatous  tumors,  without  elasticity  or  fluctua- 
tion at  any  part. 

We  must  not  be  tempted  to  follow  Mons.  Louis  into  his  account  of 
the  other  cases.  The  termination  of  his  paper  is  characteristic  of  the 
man,  and  teaches  a  lesson  which  may  apply  as  well  to  the  present  times. 

"  I  have  endeavored,  in  writing  this  memoir,  to  follow  the  precepts  laid 
down  by  Chancellor  Bacon,  in  the  second  part  of  his  great  work  on  the 
remodelling  of  the  sciences,  entitled, l  Novum  Organum  Scientiarum;' 
in  which  he  says  that  an  exact  observation  of  facts,  and  a  correct  and 
careful  induction,  is  the  true  method  of  understanding  and  interpreting 
nature.  To  use  this  induction,  says  this  great  man,  there  must  be  a 
sufficient  number  of  examples  and  facts  collected  with  exactness,  and 
shown  with  fidelity;  then,  considering  these  facts  in  every  possible 
light,  to  be  assured  that  they  do  not  contradict  one  another,  we  may  be 
secure  of  deducing  some  useful  truth,  which  will  lead  to  new  dis- 
coveries. By  this  mode  of  proceeding,  experience  and  reason  together 
assist  and  enlighten  one  another.  The  Academy  of  Surgery  has  always 
adopted  these  principles;  it  only  recognizes  as  theory  that  which  is 
based  upon  facts ;  examples  must  follow  all  rules,  and  must  apply  or 
rather  must  form  them." 

The  brothers  Wenzel  were  the  next  who  published  facts  in  confirma- 
tion of  those  of  Louis;  and  it  is  now  universally  admitted  that  fungoid 
30 


466  HUMAN   BRAIN. 

disease  of  the  dura  mater  will  sometimes  cause  absorption  of  the  bones 
of  the  skull,  and  appear  externally. 

Cruveilhier*  divides  cancerous  tumors  of  the  dura  mater  into  two 
classes:  the  one  formed  at  the  expense  of  the  external  layer,  the  other 
of  the  internal.  The  latter  are  the  most  frequent.  There  are  also 
tumors  which  originate  in  the  sub-arachnoid  cellular  tissue,  and  then, 
causing  adhesion  of  the  two  layers,  it  becomes  difficult  to  say  from 
whence  the  disease  first  sprung. 

But  more  numerous  still  are  those  encephaloid  tumors  which  spring 
from  the  tissue  of  the  bone,  and  generally  from  the  diploe.  Cruveilhier 
has  given  some  excellent  drawings  of  all  these  various  kinds.  In  the 
Museum  of  St.  Bartholomew's  there  are  several  very  good  specimens 
of  the  disease,  but  only  one  that  can  be  unequivocally  pronounced  as 
springing  from  the  dura  mater  alone. 

Dr.  Walshe  has  shown  that  these  perforating  tumors  of  the  cranium 
are  not  confined  in  their  origin  to  the  above-named  tissues,  but  they 
may  spring  from  the  pia  mater  and  cerebral  substance;  and  that  the 
subpericranial  cellular  tissue  also  occasionally  forms  the  nidus  of  this 
disease. 

Cancer  in  this  region,  says  the  above  writer,  is  rarely  attended  with 
development  of  the  disease  in  other  parts.  Among  sixty  cases,  Velpeau 
only  found  three  in  which  other  organs  were  similarly  affected. 

The  history  of  the  progress  of  these  tumors  seldom  throws  much 
light  on  their  real  nature  and  origin ;  for  even  those  which  proceed 
inwards  often  attain  a  considerable  size  before  they  produce  cerebral 
disturbance ;  and  those  which  perforate  the  skull  generally  proceed  in 
that  direction  at  once.  Their  size  is  no  guide  to  their  nature ;  they 
have  been  found  to  vary  from  that  of  a  nut  to  that  of  a  second  head: 
neither  is  the  bony  ridge  which  generally  surrounds  them,  any  indication 
of  their  nature,  for  the  most  innocent  tumors  are  occasionally  thus  im- 
bedded. Within  the  last  year  I  have  had  two  cases  under  my  care  in 
St.  Thomas's  Hospital,  of  simple  sebaceous  tumors  beneath  the  peri- 
cranium, which  had  formed  for  themselves  a  complete  cup.  One  was 
about  the  circumference  of  a  large  orange ;  it  rose  but  little  above  the 
surface  of  the  cranium,  and  this  was  surrounded  by  a  rough  ridge,  at 
least  a  third  of  an  inch  in  depth.  The  tumor  was  soft  but  elastic.  I 
removed  it  carefully,  and  then  found  the  skull  completely  depressed, 
forming  a  hollow  cup  at  least  half  an  inch  in  the  centre.  The  bone  was 
bare,  but  quite  firm  and  sound  at  the  bottom. 

What  guide,  then,  have  we  to  the  cerebral  origin  of  these  cranial 
tumors?  The  following  are  tolerably  certain,  but  they  are  not  so  uner- 
ring that,  when  absent,  the  question  can  be  considered  decided — indeed, 
the  surgeon  cannot  be  too  careful  in  operating — it  is  of  no  use  touching 
those  which  are  cancerous,  whether  inter  or  extra  cranial;  two  different 
pulsatory  movements,  and  the  effect  produced  on  the  sensorium  by 
pressure.  The  two  pulsations  are  occasioned  by  the  heart's  action,  and 
the  respiratory  movements  which  more  or  less  affect  the  brain :  they  are 
not  usually  very  tender  to  the  touch,  though  they  are  the  seat  of  those 

*  Anat.  Pathol.,  liv.  viii.  p.  2. 


ORGANIC    DISEASES    OF    THE    BRAIN.  467 

sharp  pains  which  generally  attend  the  growth  of  cancerous  disease. 
When  ulceration  takes  place,  the  real  character  of  the  disease  is  un- 
masked, and  no  one  can  mistake  it;  but  death  generally  ensues  before 
this  stage  is  arrived  at. 

There  is  no  portion  of  the  dura  mater  in  which  these  tumors  are  not 
occasionally  found,  varying,  of  course,  in  their  effects  according  to  their 
situation.  They  have  been  found  attached  to  the  falx  and  the  tento- 
rium.  Andral  relates  a  very  interesting  case  of  osteo-fibrous  tumor 
attached  to  the  tentorium,  which  by  its  pressure  on  the  left  lobe  of  the 
cerebellum  caused  much  diminution  in  its  volume,  and  changed  its 
natural  texture  into  one  of  extraordinary  hardness.  The  immediate 
cause  of  death  was  an  apoplectic  effusion  into  the  cerebrum.*  The 
tumor  was  apparently  owing  to  a  blow  received  four  years  previous  to 
death.  u  Immediately  after  the  fall  he  experienced  no  uneasiness;  sub- 
sequently, however,  he  began  to  feel  a  dull  pain  towards  the  left  part  of 
the  occipital  bone,  which  continued  for  a  considerable  time  without 
becoming  severe.  Giddiness  occurred  also  from  time  to  time,  often  fol- 
lowed by  total  loss  of  consciousness,  which  never  continued,  however, 
beyond  a  few  minutes.  At  a  later  period  new  symptoms  presented 
themselves;  on  a  sudden  the  upper  extremity  of  the  right  side  was 
attacked  with  a  painful,  and,  as  it  were,  tetanic  shock.  Five  or  six  of 
these  shocks  rapidly  followed  this,  and  during  the  three  or  four  days 
following  the  right  arm  continued  torpid,  and  somewhat  weaker  than 
that  of  the  opposite  side.  At  first  there  were  intervals  of  months  be- 
tween these  attacks ;  they  then  became  more  frequent,  re-appearing 
every  ten  or  twelve  days,  uniformly  limited  to  the  right  arm ;  and  at  the 
same  time  paralysis  of  this  limb,  at  first  transient,  but  becoming  perma- 
nent and  more  and  more  complete.  Insensibly  also  the  right  lower 
extremity  lost  the  power  of  motion;  it  never,  however,  exhibited  any 
convulsive  movement." 

Dr.  Walshe,  in  his  admirable  work  on  Cancer,  saysf — "Cancerous 
productions  occur  in  the  brain  in  both  the  tuberiform  and  infiltrated 
forms.  The  size  of  tumors  and  extent  of  infiltrations  is  subject  to  much- 
variety;  nodules  not  larger  than  a  pea  are  met  with,  as  well  as  masses 
almost  filling  the  place  of  an  entire  hemisphere.  Tumors  of  medium 
size  are,  however,  most  common.  In  the  majority  of  cases  the  brain  is 
the  seat  of  but  one  cancerous  growth;  several  are,  on  the  other  hand, 
discovered  in  certain  instances.  Cancerous  tumors  appear  in  some  cases 
actually  continuous  with  the  surrounding  brain  ;  in  others  they  are  said 
to  be  separated  from  this  by  cellular  membrane,  assuming  the  character 
of  a  cyst  in  a  third  class  of  cases,  without  being  cut  off  from  adjoining 
parts  by  a  pseudo-cyst,  they  yet  seem  deficient  in  intimate  connection 
with  the  natural  tissue  around.  The  last  mentioned  is  the  most  common 
condition.  The  left  and  right  hemispheres  seem  to  suffer  from  the  dis- 
ease with  very  nearly  equal  frequency;  both  hemispheres  are  seldom 
implicated,  and  scarcely,  as  far  as  I  have  ascertained,  except  when  the 
cerebral  affection  is  secondary.  In  nineteen  cases,  I  find  the  disease  to 
have  been  seated  in  the  left  hemisphere  in  nine,  in  the  right  hemisphere 

*   Andral,  p.  2,  op.  cit 

f  The  Nature  and  Treatment  of  Cancer,  by  Walter  Hoyle  Walshe,  M.  D.,  1846,  p.  888. 


468  HUMAN    BRAIN. 

in  eight,  in  both  hemispheres  in  two.  In  nineteen  cases,  the  lobes 
affected  were — the  posterior  in  four,  the  middle  in  nine,  the  anterior  in 
four,  the  anterior  and  middle  in  one,  all  three  lobes  in  one.  In  one  of 
these  nineteen  cases  the  optic  thalamus,  in  two  the  corpus  striatum,  and 
in  one  both  these  parts  were  the  seats  of  the  cancer.  I  have  met  with 
one  example  only  of  implication  of  the  convolutions  as  an  apparently 
primary  state,  and  none  of  limitation  of  the  disease  when  primary  to 
those  parts;  they  appear  to  suffer  but  rarely  by  extension  of  cancerous 
infiltration  from  adjacent  textures." 

Cancer  is  found  both  as  a  primary  disease  of  the  brain  and  a  second- 
ary one.  Not  a  few  cases  are  on  record  where  every  other  organ  in  the 
body  was  healthy  except  the  brain.  Its  progress  is  variable,  sometimes 
rapid,  though  not  generally  so.  Its  presence  is  generally  indicated  by 
the  inflammation  which  it  induces  in  the  surrounding  substance  or  in  the 
membranes. 

The  following  case,  which  I  related  in  the  Medical  Gazette  in  1832, 
illustrates  the  progress  of  this  disease,  and  shows  its  insidious  charac- 
ter. It  also  is  an  instance  of  the  cause  of  death,  being  the  inflamma- 
tion and  serous  effusion  occasioned  by  the  tumor,  and  not  the  tumor 
itself.  It  is  interesting  also  from  the  rarity  of  this  form  of  cancer  in  the 
brain,  but  especially  in  a  child: — 

Case  95. — *  George  N •,  aged  four  years  and  three  months.  This  child,  after  having 

been  inactive  and  sleepy  for  several  months,  was  seized,  on  the  9th  of  August,  1831,  with 
an  epileptic  fit,  which  lasted  some  hours,  but  was  ultimately  relieved  by  venesection, 
leeches,  and  purgatives,  with  cold  applications  to  the  head.  His  stools  were  at  this  time 
without  bile ;  urine  high  colored,  and  notwithstanding  the  daily  use  of  the  mercurial  oint- 
ment and  calomel,  with  scammony.  until  the  24th  (amounting  to  60  grains  of  calomel,  and 
1  ounce  of  ung.  hydr.),  no  change  was  effected  in  the  secretions;  and  after  that,  aloes  were 
resorted  to,  when  the  stools  immediately  assumed  a  natural  appearance,  and  the  urine  lost 
its  high  color,  and  the  child  was  apparently  well.  Medicine  soon  after  discontinued;  but, 
however,  before  long,  he  again  gradually  became  sleepy  and  forgetful:  and  he  would  fre- 
quently lay  his  head  down,  as  if  it  were  too  heavy  to  support.  For  the  last  two  months 
previous  to  his  death,  his  intellect  seemed  impaired,  though  not  to  any  great  extent.  He 
occasionally  forgot  words  when  he  was  speaking,  and  paid  very  little  attention  to  passing 
events,  though  he  always  understood  what  was  said  to  him. 

On  the  19th  of  February,  1832,  medical  aid  was  again  sought.  Bleeding,  purgatives  and 
blistering  were  directed;  but  the  parents,  feeling  convinced  of  the  inutility  of  these  mea- 
sures, declined  adopting  them.  He  died  on  the  24th,  having  laid  two '  days  in  a  state  of 
coma. 

Postmortem  appearances. — On  cutting  through  the  dura  mater,  the  brain  bulged  out  through 
the  incision,  being  evidently  distended.  The  convolutions  were  slightly  unfolded,  and  the 
sulci  between  them  partially  obliterated.  Neither  the  arachnoid,  pia  mater,  or  substance  of 
the  brain,  were  more  vascular  than  usual.  The  right  lateral  ventricle  was  found  distended 
by  fluid;  the  septum  lucidum  bulged  in  from  the  pressure  of  the  fluid  in  the  opposite  ven- 
tricle; the  arachnoid  lining  the  ventricles  was  much  thickened;  the  quantity  of  fluid  con- 
tained in  both  ventricles  was  about  six  ounces. 

On  proceeding  with  the  section  of  the  left  hemisphere,  a  tumor  was  discovered  in  the 
posterior  lobe ;  it  was  about  the  size  of  a  hen's  egg,  but  not  perfectly  homogeneous  in  its 
texture ;  the  most  external  portion  looked  as  if  it  consisted  merely  of  a  deposition  of  fibrin, 
situated  in  which  there  were  many  vascular  points,  and  also  small  irregular  patches  of  a 
thick  yellow  fluid,  varying  in  size  from  a  pin's  head  to  a  pea.  This  deposition  formed  a 
sort  of  coating  round  the  central  tumor,  which  was  as  large  as  a  pigeon's  egg;  though  its 
edges  were  not  distinctly  defined,  it  was  nearly  as  firm  as  cartilage,  of  a  pearly  gray  white 
color,  slightly  granular  on  section,  with  claws,  as  it  were,  shooting  out  from  the  centre;  it 
was  separated  from  the  posterior  cornua  by  a  very  thin  layer  of  medullary  matter,  and  the 
thickened  arachnoid  which  lined  the  ventricle.  The  rest  of  the  brain  perfectly  healthy. 


*  Med.  Gaz.,  x.  p.  191. 

,3*8.1 ,£  y.  •:  '     • 


ORGANIC    DISEASES   OF   THE   BRAIN.  469 

The  non-malignant  tumors  and  membranes  of  the  brain  are  the  fibrous, 
osseous,  tubercular,  hydatid,  steatomatous,  fleshy  or  kidney-like  tumors:  all 
these  various  morbid  products  have  been  found  by  different  pathologists. 
Dr.  Copland  has  given  a  very  full  and  learned  account  of  them,  which 
I  shall  not  attempt  to  approach  ;  of  all  these  deposits  in  the  brain,  the 
tubercular  are  the  most  common,  especially  in  children,  though  it  is  not  so 
frequently  found  in  this  situation  as  in  the  lungs  or  the  lymphatic  glands. 
It  presents  the  same  physical  and  microscopic  characters  in  the  brain  as 
elsewhere.  The  situation  of  it  in  the  brain  varies  much,  but  it  is  not 
so  frequently  found  in  those  parts  which  are  most  frequently  attacked 
with  inflammation,  namely,  the  hemispherical  and  other  cerebral  ganglia. 
It  is  found  in  the  tubular  neurine  of  the  hemispheres,  cerebellum,  crura, 
pons  Varolii,  &c. 

Dr.  Bright  frequently  met  with  them  in  the  cineritious  neurine,  but  I 
think  that  this  is  not  the  general  rule. 

Dr.  Hennis  Green,  in  an  admirable  paper  on  this  subject,*  points  out 
its  frequency  in  children  as  compared  with  adults.  Cruveilhier  never 
saw  an  example  in  advanced  life.  Louis  met  with  only  a  single  case  in 
117  cases  of  phthisis  among  adults.  And  Lugol  assures  us  that  in  his 
extensive  practice  at  the  Hospital  of  St.  Louis,  he  has  seen  only  eight 
cases  of  the  disease  ;  in  four,  the  tuberculous  matter  occupied  the  cere- 
brum; in  three  the  cerebellum  ;  and  in  one  the  pons  Varolii.  In  six  of 
these  eight  cases  no  symptoms  existed  during  life  ;  and  M.  Lugol  affirms, 
"  that  the  diagnosis  of  cerebral  tubercle  is  involved  in  the  greatest  ob-. 
scurity."  Dr.  Abercrombie  only  relates  one  case  from  his  own  practice, 
which  occurred  in  a  man  thirty-four  years  of  age.  "  In  children,  on  the 
contrary,"  says  Dr.  Hennis  Green,  "tubercle  of  the  brain  is,  compara-t 
tively  speaking,  a  frequent  affection.  I  have  observed  one  case  to  every 
fifty-one  in  1324  cases  of  acute  diseases."  In  seventy-five  cases  this 
author  found  that  they  had  occurred  most  frequently  from  three  to  seven 
years  of  age.  Tubercles  vary  in  size,  from  that  of  a  pea  to  that  of  a  large 
egg;  in  number,  from  that  of  a  single  mass  to  that  of  fifty. 

"In  no  instance,"  says  the  same  author,  "was  the  affection  confined 
to  the  brain.  Tubercles  or  tubercular  deposit  were  invariably  found  at 
the  same  time,  either  in  the  thoracic  or  abdominal  cavities;  but  in 
several  cases  the  greater  development  of  the  tubercles  in  the  brain  leads 
to  the  idea,  that  the  disease  commenced  in  the  nervous  system." 

Tubercle  in  the  brain  generally  destroys  life,  b.y  exciting- inflammation 
of  a  low  sub-acute  character.  In  children  this  is  generally  followed  by 
effusion  into  the  ventricles.  It  will  often  remain  dormant  for  a  time,  and 
then  suddenly  alarming  symptoms  will  appear,  and  prove  fatal  in  a  few 
days. 

The  following  case  is  interesting  In  this  point  of  view,  and  also  in 
another,  to  which  the  attention  of  surgeons  is  very  frequently  directed, 
namely,  whether  by  healing  external  st rumpus  sores  internal  disease  is 
excited.  In  this  case  the  internal  appeared  to  be  dormant,  while  the 
external  was  going  on,  and  a^  soon  as  the  external  was  cured  the  inter- 
nal disease  appeared. 

*  Med.-Chir.  Traps.,  vol.  *xi.  p.  192,  ^ad  January  and  June  1842. 


HUMAN    BRAIN. 


Case  96. — T.  B.  P.,  a  child  four  years  old,  was  under  my  care  in  St.  Thomas's  Hospital, 
•with  strumous  disease  of  the  elbow  joint,  but  without  any  indication  of  cerebral  disease,  nor 
was  anything  told  us  by  the  mother  to  call  our  attention  to  the  head.  I  ordered  the  Cod- 
liver  Oil  3J.  t.  d.,  and  the  Tinct.  of  Iodine  to  the  chest,  as  I  was  a  little  fearful  regarding 
the  lungs.  The  elbow  was  firmly  fixed  by  means  of  a  pasteboard  splint.  The  child's  health 
improved  in  the  hospital,  as  regards  his  appetite  and  appearance,  but  some  superficial  scars 
of  old  wounds  ulcerated  and  became  small  sores ;  he  was  in  the  hospital  about  five  weeks; 
the  sores  healed,  and  the  elbow  joint  became  free  from  pain.  Soon  after  he  left  the  hospital 
his  health  again  declined,  and  he  then  complained  of  his  head,  but  they  had  no  advice  for 
him  until  he  was  seized  with  a  fit,  about  one  month  after  leaving  the  hospital,  on  the  19th 
of  March;  it  was  slight,  and  only  lasted  a  few  minutes,  but  it  was  followed  by  others  on 
the  two  following  days:  on  the  third  day  the  child  became  quite  insensible;  in  this  state 
they  brought  him  again  to  me.  He  had  now  all  the  signs  of  effusion  on  the  brain;  from 
these  symptoms  he  never  rallied  at  all,  and  died  in  four  days  from  the  time  of  his  first  be- 
coming comatose.  When  the  child  was  brought  to  me  with  signs  of  cerebral  mischief,  I 
learnt  the  following  of  his  early  history : — When  about  two  years  old  he  complained  much 
of  pain  in  his  head,  with  disturbance  of  his  bowels  and  enlargement  of  the  abdomen,  loss 
of  appetite  and  general  lassitude  ;  by  judicious  treatment  lie  got  well,  and  remained  so  until 
about  a  few  weeks  previous  to  his  coming  into  the  hospital;  at  this  time  he  was  seized  with 
a  convulsive  fit,  which  lasted  six  hours ;  he  had  four  leeches  behind  the  ears,  warm  bath, 
and  purgatives.  About  a  week  after,  the  elbow  contracted  and  became  painful,  the  head 
being  quite  well  and  comfortable,  so  that  when  he  came  to  the  hospital  nothing  was  said 
regarding  his  head. 

Post-mortem  examination,  24  hours  after  death.  Weather  cool.  Membranes  healthy ;  con- 
volutions flattened ;  ventricles  distended  with  serum  to  nearly  three  times  their  natural  size. 
In  the  centre  of  the  inferior  vermiform  process  of  the  cerebellum  there  was  a  firm  yellow 
scrofulous  tubercle,  about  the  size  of  a  large  marble ;  it  was  much  harder  than  healthy 
neurine.  The  neurine  immediately  surrounding  it  was  slightly  softened,  but  beyond  a  hair's 
breadth  it  was  all  quite  healthy.  Lungs  and  heart  healthy ;  as  also  the  abdominal  viscera. 

The  plexus  choroides  is  sometimes  the  seat  of  organic  disease.  One 
of  the  most  common  changes  in  its  condition  is  a  consolidation  and  hy- 
pertrophy of  its  tissue.  It  is  doubtful  whether  this  fleshy  appearance 
is  the  effect  of  repeated  dilatation  of  its  vessels,  or  a  true  morbid  growth. 
I  am  npt  aware  that  it  has  been  connected  with  any  peculiar  symptoms 
during  life. 

Still  more  frequently  do  we  find  this  portion  of  the  pia  mater  the 
nidus  of  small  vesicular  bodies  like  hydatids,  but  they  are  not  so — they 
are  merely  cysts  containing  serum.  Dr.  Bright  considers  them  as  occa- 
sionally the  predisposing  causes  of  apoplexy. 

Among  the  morbid  adventitious  structures  which  are  met  with  in  the 
brain,  we  must  not  omit  to  mention  hamatoma,  as  it  has  been  designa- 
ted by  Dr.  Hooper  in  his  illustrations  of  diseases  of  the  brain.  It  is 
doubtful  whether  this  disease  is  anything  but  a  form  of  fungus  hsema- 
todes. 

Dr.  Hooper  has  given  a  very  beautiful  drawing  of  this  disease,  which 
he  thus  describes:  "  This  tumor  is  fungous,  and  takes  its  origin  from 
the  medullary  substance  of  the  cerebrum  near  the  ventricle,  but  has  no 
connection  or  communication  whatever  with  that  cavity.  It  has  a  broad 
base,  and  in  making  its  way  outward  has  separated  the  convolutions  of 
the  brain  to  some  distance  from  each  other.  Externally  it  is  covered 
by  the  pia  mater,  over  which  there  is  a  very  vascular  membrane,  which 
is  either  the  arachnoid  altered  by  disease,  or  an  adventitious  membrane 
produced  by  inflammation.  This  fungus  is  irregularly  lobulated.  To 
the  touch  it  feels  soft  and  is  somewhat  elastic.  It  cut  as  firm  as  brain, 
and  presented  a  vascular  mottled  surface,  of  a  reddish  yellow  color, 
with  portions  here  and  there  of  a  coagulated  blood-like  substance." 


ORGANIC    DISEASES    OF    THE    BRAIN. 


471 


"  The  circumstances,"  says  Dr.  Walshe,*  "  most  distinctly  permit- 
ting the  physician  to  affirm  that  a  tumor  exists  within  the  cranium,  are, 
the  existence  for  a  considerable  period  of  intense  cephalalgia,  especially 
limited  to  a  fixed  point,  or  even  to  one  side  of  the  head,  and  if  attended 
with  repeated  vomiting;  of  convulsive  movements  without  paralysis, 
but  followed  by  mere  weakness,  or  actual  paralysis  of  the  affected  parts ; 
of  different  affections  of  the  organs  of  sense,  especially  alteration  of  sight, 
and  of  disturbance  of  intellect,  while  the  general  health  does  not  very 
materially  suffer.  But  the  previous  details  show  that  such  a  combina- 
tion of  circumstances  will  not  very  commonly  exhibit  itself." 

Dr.  Abercrombie  does  not  attempt  to  connect  any  particular  symptoms 
with  the  various  forms  of  organic  diseases,  but  he  gives  a  very  inter- 
esting outline  of  the  principal  modifications  of  these  symptoms  in  the 
aggregate,  of  which  the  following  may  be  considered  as  an  abstract: — 

First — Long-continued  and  severe  headache,  the  pain  varying  both 
in  seat  and  severity,  sometimes  occurring  in  regular  paroxysms,  leaving 
intervals  of  comparative  or  complete  relief. 

In  some  cases  the  pain  is  acute  and  lancinating;  in  others,  obtuse; 
sometimes  referred  to  a  particular  spot,  as  the  occiput,  or  one  temple. 
In  the  more  violent  paroxysms  the  pain  is  intense,  obliging  the  patient 
to  remain  for  a  considerable  time  in  one  position,  the  slightest  motion 
aggravating  it  to  perfect  torture;  but  the  remissions  from  this  severe 
suffering  are  often  so  remarkable  as  to  lead  a  superficial  observer  into 
the  belief  that  it  is  merely  periodical  headache,  or  headache  connected 
with  dyspepsia.  Formerly  the  disorder  of  the  stomach,  which  frequently 
accompanies  these  organic  diseases,  was  supposed  to  be  confirmatory  of 
this  view;  but  now  medical  men  regard  justly  the  vomiting  which  often 
attends  these  headaches  as  a  most  serious  symptom,  directing  their  at- 
tention especially  to  the  brain.  In  vomiting  from  dyspepsia,  the  head- 
ache is  generally  relieved  after  the  stomach  has  been  emptied;  but  not 
so  in  these  cases. 

Secondly — In  another  form,  after  some  continuance  of  fixed  pain,  the 
organs  of  sense  become  affected,  as  the  sight,  the  hearing,  the  taste,  and 
flic  smell ;  ptosis  or  paralysis  of  the  upper  eyelids  ensues  ;  and  lastly, 
the  intellect  gradually  becomes  dull  and  the  memory  imperfect.  All 
such  symptoms  must  of  course  depend  on  the  exact  seat  of  the  tumor ; 
the  loss  of  power  in  the  different  nerves  depending  on  pressure  either  of 
the  nerve  or  of  its  ganglion.  When  the  tumor  is  seated  so  as  to  oppress 
the  nerve  alone,  the  loss  of  the  use  of  the  organ  which  it  supplies  will 
be  the  only  result ;  but  if  the  ganglion  be  affected,  especially  those  of 
the  optic  and  auditory  nerves,  a  much  more  serious  set  of  symptoms  will 
rapidly  ensue,  such  as  convulsions  and  more  or  less  general  paralysis. 

Thirdly — If  the  tumors  happen  to  be  developed  in  the  tubular  neurine, 
and  not  in  or  on  any  of  the  ganglia,  the  first  indication  of  their  existence 
will  be  an  excitation  of  the  muscular  system,  and  the  result  of  this  ex- 
citation— convulsions.  Sometimes  these  convulsions  appear  under  the 
regular  form  of  epilepsy,  but  generally  more  irregular;  sometimes  violent 
paroxysms  of  headache  precede  the  convulsions,  which  are  not  usual  in 

*  Op.  oil.,  p.  495. 


472  HUMAN   BRAIN. 

functional  epilepsy.  Tubercles  in  the  cerebellum,  in  the  tubular  neurine 
of  the  hemispheres,  pons  Varolii,  and  crura,  will  give  rise  to  these  con- 
vulsions ;  also  spiculaB  of  bone  when  they  reach  the  medullary  structure. 
Patients  often  die  in  the  convulsions.  If  they  are  not  rapidly  cut  off 
there  is  generally  some  paralysis  of  one  or  more  of  the  limbs.  There 
are  some  few  cases  where  paralysis  occurs,  without  being  preceded  by 
more  or  less  convulsive  action  of  the  muscles,  but  this  is  not  often  the 
case  in  organic  diseases. 

Fourthly — There  are  a  class  of  cases  which  I  believe  occur  very  rarely, 
but  which  Dr.  Abercrombie  describes  in  these  words:* — "  This  class 
calls  our  attention  to  a  train  of  symptoms  which  are  referred  to  the  sto- 
mach, but  which  really  depend  upon  disease  of  the  brain.  In  many  of 
the  cases  of  organic  disease  of  the  brain  the  stomach  is  affected;  but 
those  to  which  I  now  allude  are  remarkable  from  the  affection  in  the 
stomach  being  the  prominent  symptom.  In  these  there  is  often,  through 
a  considerable  part  of  their  progress,  very  little  complaint  of  the  head, 
or  no  complaint  so  fixed  and  urgent  as  to  direct  our  attention  to  the  brain 
as  the  seat  of  disease.  There  is  generally,  however,  some  pain  or  weight 
in  the  head,  sometimes  occurring  in  paroxysms  like  periodical  headache, 
or  in  paroxysms  accompanied  by  vomiting,  like  what  is  commonly  called 
sick  headache.  The  pain  is  increased  by  exertion,  external  heat,  pas- 
sions of  the  mind,  and  stimulating  liquors;  there  is  generally  variable 
appetite,  bad  sleep,  oppression  of  the  stomach,  and  frequent  vomiting. 
The  vomiting  sometimes  occurs  in  the  morning  on  first  awaking,  and 
sometimes  at  uncertain  intervals,  and  very  suddenly,  without  any  pre- 
vious sickness.  There  are  in  general  uneasy  sensations  referred  to  vari- 
ous organs,  by  which  the  nature  of  the  disease  may  be  disguised  in  its 
earlier  periods;  but  after  a  certain  time  symptoms  referable  to  the  head 
generally  begin  to  appear,  such  as  fits,  loss  of  recollection,  convulsive 
paroxysms,  and  affections  of  sight.  After  this  stage  of  the  disease  death 
may  occur  suddenly  in  an  attack  of  convulsion,  or  it  may  be  preceded 
by  a  train  of  severe  suffering.  In  cases  of  this  class  we  must  beware  of 
being  misled  in  regard  to  the  nature  of  the  complaint,  by  observing  that 
the  symptoms  in  the  stomach  are  alleviated  by  a  strict  regimen,  or  by 
treatment  directed  to  the  stomach  itself.  If  digestion  be  impeded,  from 
whatever  cause,  the  uneasy  symptoms  may  in  this  manner  be  alleviated; 
but  no  inference  can  be  drawn  from  this  fact  in  regard  to  the  cause  of 
the  derangement.  In  the  earlier  periods  of  this  affection  the  diagnosis 
is  indeed  often  very  difficult.  There  is  generally  more  permanent  and 
fixed  uneasiness  in  the  head  than  we  should  expect  to  find  in  a  dyspeptic 
case,  and  the  uneasiness  is  increased  by  causes  which  would  probably 
be  beneficial  to  a  dyspeptic  headache,  such  as  activity  and  cheerful 
company.  The  prominent  morbid  appearances  in  cases  of  this  class 
seem  to  be  in  the  cerebellum." 

Fifthly — There  are  some  cases  which  might  at  first  be  mistaken  for 
apoplexv  of  a  slight  transient  character,  until  the  repetition  of  the  symp- 
toms rather  frequently  and  without  any  great  increase  in  severity  shows 
that  they  cannot  be  dependent  on  effusion  of  blood  ;  for  when  the  effu- 

*  Abercrombie,  p.  321,  op.  cit 


ORGANIC    DISEASES    OF   THE   BRAIN.  473 

sion  is  repeated  in  the  brain  the  second  attack  is  almost  always  worse 
than  the  first,  and  so  on.  In  some  cases  it  consists  chiefly  of  an  habitual 
giddiness,  which  makes  the  patient  afraid  to  walk  alone;  in  others  there 
are  sudden  attacks  of  all  muscular  power  without  loss  of  recollection, 
which  are  soon  recovered  from.  Sometimes  there  are  attacks  of  perfect 
coma,  which  may  occur  at  regular  or  at  irregular  intervals,  the  patient 
having  in  some  cases  such  warning  of  their  approach  that  he  goes  to  bed 
before  the  attack.  There  is  usually  more  or  less  unsteadiness  of  the 
limbs,  and  generally,  but  not  always,  headache.  In  some  cases  there 
are  affections  of  the  sight,  and  these  may  either  be  permanent  or  occur 
in  paroxysms;  and  in  some  cases  giddiness  and  loss  of  recollection  are 
excited  by  bodily  exertion,  and  go  off  on  desisting  from  it. 

The  following  case  illustrates  very  forcibly  the  fact  that  tumors  of  the 
brain  may  be  formed  and  grow  to  a  considerable  size  without  giving  rise 
to  any  striking  cerebral  symptoms  until  they  excite  inflammation  in  the 
surrounding  cerebral  substance.  The  subject  of  the  present  history  I 
had  known  for  many  years,  and  was  in  the  habit  of  seeing  him  fre- 
quently. He  never  complained  of  his  head  to  me,  though  he  used 
occasionally  to  consult  me  for  slight  ailments.  Since  his  death  I  have 
learnt  that  he  had  not  been  quite  so  active  as  formerly,  and  that  he  used 
frequently  to  put  his  hand  up  to  his  head,  but  he  never  complained 
much,  and  attended  to  his  business  regularly  up  to  the  date  of  the  attack 
now  to  be  recorded.  He  used  always  to  take  a  walk  before  breakfast, 
and  appeared  to  enjoy  life  as  much  as  other  persons.  I  was  guided  in 
my  treatment  more  by  my  previous  knowledge  of  the  general  character 
of  his  constitution  when  in  his  usual  state  of  health,  than  merely  by  the 
symptoms  attending  the  onset  of  the  attack. 

Case  97. — May  20th,  1847. — I  was  requested  to  visit  a  gentleman,  by  his  brother,  who 
feared  that  he  was  threatened  with  an  attack  of  paralysis.  My  visit  was  paid  immediately, 
at  10  A.  M.  I  found  him  lying  on  the  sofa,  in  a  sleepy  state;  he  had  only  just  risen,  but  he 
complained  that  he  was  so  drowsy  that  he  did  not  know  what  to  do.  He  is  stout  and  fat, 
and  of  lax,  flabby  fibre,  a3t.  46,  residing  at  his  place  of  business  in  the  city,  and  taking  very 
little  exercise.  Living  well,  and  though  not  positively  intemperate,  still  occasionally  taking 
porter,  and  brandy  and  water,  and  cigars,  before  going  to  bed.  This  he  has  not  done  for  the 
last  few  days.  Last  night  he  had  some  cheese  for  supper,  and  brandy  and  soda-water  with 
it,  about  half-past  10;  he  went  to  bed  about  half-past  11.  He  says  that  he  slept  badly, 
dreaming  a  good  deal,  and  that  he  awoke  with  headache.  He  has  been  slightly  sick  this 
morning ;  has  not  yet  had  any  breakfast.  His  eyes  are  slightly,  but  very  slightly,  congested, 
the  pupils  perfectly  natural ;  says  his  headache  is  over  the  forehead — thinks  it  is  a  little 
more  on  the  right  side  than  the  opposite.  The  face  is  decidedly,  though  slightly,  drawn  to 
the  right  side;  the  tongue  is  protruded  straight.  He  has  no  numbness  anywhere.  He  says 
that  he  has  no  loss  of  power  in  either  arm  or  leg.  Feels  sick,  and  inclined  to  vomit.  His 
bowels  have  not  been  open  this  morning — he  is  not  a  subject  to  bear  blood-letting;  pulse  13 
in  the  quarter,  23  in  the  half,  62 — soft  and  full;  hands  and  feet  cold,  as  is  usual  to  him. 

Ord. — Leeches,  xij.  capitis  dextri  lateri.  Seidlitz  powder  in  infusion  of  ginger ;  feet  in 
hot  water. 

5  p.  M. — Much  the  same,  the  Seidlitz  has  not  acted ;  complains  of  his  head.  Ord. — Enema 
Tereb.  ^j.  ad  Ib.  Hirud.  xij.  lotio  frigida.  Pulse  slow  and  feeble. 

10  p.  M. — Much  the  same ;  no  inclination  for  food ;  says  his  head  is  easier  since  the 
leeches ;  finds  it  more  comfortable  when  it  is  rather  low  than  high.  Bowels  not  open  ; 
pulse  60,  full  and  soft,  quite  regular;  hands  and  feet  warm.  Ord. — Cal.  gr.  iv.  6tk*  horis. 
Emp  Lyttae  nuch. 

21st. — Has  passed  a  restless  night,  complaining  of  his  head;  cannot  bear  to  have  it  raised; 
the  blister  has  been  rubbed  off  repeatedly  during  the  night.  Bowels  not  opened ;  they  are 
not  generally  obstinate;  pulse  56,  soft  and  regular;  perfectly  rational,  answers  immediately 
and  distinctly;  pupils  quite  natural ;  tongue  furred  in  the  centre,  flabby  and  indented  on  the 
side ;  no  inclination  for  food  or  drink. 


474  HUMAN   BRAIN. 

Ord. — Cal.  to  be  continued,  and  hair  to  be  cut  very  short.     Rep.  Enema  Terebinth. 

5  p.  M.  Enema  has  returned  immediately;  bowels  have  not  acted;  head  very  uncom- 
fortable, but  the  intellect  intact;  pulse  56;  head  hot. 

Ord. — Olei  Tiglii  Tl\j.  Before  this  was  given,  the  bowels  acted.  C.  Cruentee  temporibus 
ad^viij. 

10  p.  M.— Better;  head  more  comfortable.     Ord. — Cal.  gr.  iv.  bis  4ta  hora  postea  6ta  hora. 

22d. — Has  had  a  better  night;  pulse  56,  soft.  Bowels  open,  urine  abundant.  Tongue 
cleaning;  decidedly  better;  continue  the  calomel. 

23d,  9  A.  M. — Says  he  has  had  a  better  night;  quite  rational;  head  cooler;  to  continue 
the  calomel. 

3  p.  M. — Bowels  not  open  ;  rather  more  drowsy.  Ord. — Infus.  Senna  ^ij.  Magnes.  Sulph. 
^ss.  Syrup  Zinzib.  gij. 

8  p.  M. — Very  drowsy,  but  no  stertor;  answers  rationally  but  slowly,  and  says  his  head  is 
decidedly  better;  pulse  56,  soft;  bowels  confined.     Ord. — Enema  Terebinth. 

10  p.  M. — Bowels  opened;  a  good  deal  exhausted  getting  out  of  bed;  very  drowsy.  Ord. 
to  continue  the  calomel. 

May  24th,  9  A.  M. — Addressed  me  cheerfully  when  I  entered  his  room ;  said  he  had  a 
good  night.  The  nurse  says  he  slept  well.  Pulse  soft  and  slow;  tongue  furred;  mouth 
slightly  tender;  bowels  open;  has  not  taken  any  calomel  since  my  last  visit.  Ord. — Garga- 
risma  sodae  chloratis  ^j.  ad  ^vij.  Nurse  says  she  has  observed  some  convulsive  trembling 
in  his  arms,  but  not  more  on  one  side  than  the  other.  He  says  his  head  is  easy  when  it 
rests  on  the  pillow,  but  that  he  cannot  raise  it  without  pain. 

12  A.  M. — Pulse  48,  soft;  cheerful;  no  change.     Repeat  Cal.  gr.  iv. 

5  p.  M. — Not  so  well;  more  drowsy;  eyes  congested;  pulse  48;  quite  conscious,  but  says 
he  only  wants  to  be  left  alone.  Feeling  it  was  a  question  whether  he  would  not  be  better 
for  the  loss  of  more  blood,  I  sought  a  consultation  with  Dr.  Cobb.  He  went  into  the  case 
most  carefully,  and  agreed  in  the  propriety  of  cupping  from  the  head.  Suggested  giving 
him  a  little  ammonia,  thus — Liq.  Ammon.  Acet.  giij.  Ammon.  Carbon,  gr.  v.  Aq.  distill,  gj 
(jtis.  horis.  As  his  mouth  is  tender,  we  may  suspend  the  calomel. 

10  p.  M. — Rather  relieved  by  the  cupping;  pulse  52.     Says  his  head  is  more  comfortable. 

25th. — Much  better ;  cheerful ;  countenance  improved,  not  so  red ;  eye  less  injected. 
Continue  the  ammonia. 

9  P.  M. — Ord. — Pil.  Aloes  gr.  viij.  Hyd.  Chlorid.  gr.  ij.  n.  m. 

26th,  9  A.  M. — Bowels  open ;  much  the  same.     Continue  the  ammonia. 

12  A.  M. — Much  the  same. 

9  P.  M. — The  nurse  says  he  has  been  slightly  wandering  in  his  mind,  asking  repeatedly 
for  brandy  and  water,  and  then  talking  about  a  party  he  had,  and  that  his  brother  would  be 
annoyed  by  the  row  they  kicked  up.  She  also  said  that  he  had  been  very  restless,  not 
sleeping  at  all.  When  I  saw  him,  he  answered  quite  rationally  ;  but  on  the  nurse  telling 
him  to  ask  me  if  he  might  have  what  he  had  been  asking  for,  he  said, "  Brandy  and  water," 
in  a  sharp,  snappish  tone,  unlike  his  usual  manner.  From  this  account,  I  judged  that  there 
was  threatening  of  delirium  tremens,  and  I  determined  to  give  him  an  opiate. 

Ord. — Liq.  Opii  sed.  TT\,xx.  Liq.  Hyd.  Bichlorid.  gj.  Aq.  Menth.  |[j.  h.  n. 

27th,  9  A.  M. — Has  passed  a  quiet  night;  dozing  this  morning.  Nurse  says  he  awoke 
rational  this  morning.  When  she  asked  him  if  he  would  have  tea,  he  said,  "  No,  not  at 
present,  some  toast  water."  Much  the  same  during  the  day.  Continue  the  ammonia. 

In  the  evening  rather  restless.     Ord. — Liq.  Opii  ut  antea. 

28th. — Much  the  same.     Continue  the  ammonia. 

29th. — Mouth  still  tender  from  the  mercury;  tongue  foul;  very  feeble,  when  moving 
from  one  room  to  another;  passes  all  his  urine  in  bed,  involuntarily;  dozes  and  rambles. 

9  p.  M. — Has  had  a  goood  deal  of  twitching  in  the  arms  and  legs ;  countenance  not  more 
drawn  than  before.     Dr.  Cobb  saw  him  with  me,  and  thought  him  rather  better.     We 
ordered  Potass.  Oxymur.  J}j.  ex  aq. 

30th. — Went  to  sleep  about  10,  and  therefore  the  nurse  did  not  give  him  the  Liq.  Opii. 
He  awoke  about  2  o'clock,  and  was  then  restless,  but  he  went  to  sleep  again  without  any 
opium.  When  I  saw  him  at  9  A.  M.,  he  answered  cheerfully,  but  he  was  inclined  to  ramble. 
Pulse  56. 

Ord. — Continue  the  Ammonia  and  Potass.  Oxymur. 

10  p.  M. — Has  taken  more  nourishment  to-day,  but  has  been  very  restless,  talking  a  great 
deal  about  whisky  and  water,  sherry,  &c.     Has  not  slept  at  all  during  the  day ;  has  taken 
his  draught,  and  is  now  asleep. 

31st. — Much  the  same  all  day.     Continue  the  same. 

June  1st. — Better;  more  cheerful  and  more  collected;  set  up  during  the  day;  eat  a  little 
meat  for  dinner.  In  the  evening  was  quite  silly,  wanting  to  put  his  boots  on,  and  go  out ; 
would  not  go  to  bed.  They  sent  for  me,  and  in  my  absence  Dr.  Cobb  kindly  attended.  The 


ORGANIC   DISEASES   OF   THE   BRAIN.  475 

excitement  of  seeing  him  brought  him  to  himself,  and  he  went  to  bed  quite  quietly  at  half- 
past  10.  At  11,  I  found  him  sleeping  soundly,  without  any  opiate  draught.  I  ordered  it 
to  be  given  if  he  awoke,  and  was  restless. 

June  2d. — Cheerful  and  collected ;  has  eat  an  egg  for  his  breakfast ;  says  he  is  much 
better.  He  awoke  about  2  in  the  morning,  took  the  opiate  draught,  and  then  went  to  sleep 
again.  Ord.  to  continue  the  Potash,  Oxymur.  and  Ammonia. 

12. — Saw  him  with  Dr.  Cobb,  in  order  to  decide  as  to  the  propriety  of  giving  him  some 
beer  with  his  dinner.  He  agreed,  and  we  allowed  it  to  him*. 

6  p.  M. — All  the  better  for  the  ale  (Hodgson's). 

3d. — Has  had  a  good  night.  Awoke  about  2,  and  took  the  opiate  draught ;  has  been 
able  to  retain  his  water  since  the  31st;  pulse  60. 

4th. — Continues  to  improve. 

5th,  9  A.  M. — Cheerful  and  collected;  has  passed  a  pretty  good  night. 

3  P.  M. — Mrs.  B.  complains  that  he  has  been  rambling  a  good  deal,  asserting  quite  confi- 
dently that  he  had  been  at  Dalston  the  night  before,  and  showing  delusions  on  other 
points.  Pulse  soft,  50.  This  incoherency  passed  off  after  he  had  his  dinner  ;  and  when  I 
saw  him  at  3,  he  was  quite  rational.  I  ordered  him  a  meat  supper,  with  another  glass  of 
bitter  beer,  and  Liq.  Opii  sedative  TT^xxx.  hora  somni. 

11  P.M. — Has  been  quite  sensible  all  the  evening;  enjoyed  his  supper  at  7  ;  took  his 
draught  at  9;  went  oft'  to  sleep  quietly.  Slept  well  till  4  ;  got  out  of  bed  to  evacuate;  re- 
turned again  quietly  and  went  to  sleep,  and  slept  till  between  8  and  9. 

6th,  9  A.  M. — Found  him  cheerful  and  perfectly  collected ;  pulse  soft,  50 ;  slept  well. 

R.  Infus.  Calurnbae  ^v.  Ammon.  Sesquicarb.  %ss.  Spirit  Myrist.  gij.  Tinct.  Card.  co. 
£vi.  M.  ft.  Mist.  6ta<  bis  die  11  A.  M.  and  4  P.M.  This  mixture  was  continued  till  June  17th. 

R.  Liq.  Opii  sedat.  gss.     Mist.  Camph.  ^j.  M.  ft.  Haust.  h.  n.  s.  et  repet  3  si  opus  sit. 

R.  Infus.  Senna  ^iss.  Magn.  Sulph.  giij.  M.  ft.  Syr.  Zinzib.  ^j.  M.  ft.  Haust.  mane  sum  si 
opus  sit.  Two  or  three  aperient  draughts  have  been  taken. 

6th. — About  11  P.  M.  I  took  him  nine  miles  out  of  town  in  an  open  carriage.  He  was 
quite  himself;  enjoyed  the  ride,  and  a  mutton  chop  and  pint  of  ate  at  the  end  of  it.  I 
left  him  then  in  other  hands,  with  directions  for  the  same  plan  of  treatment  to  be  followed. 

10th. — Going  on  well  in  every  respect. 

12th. — R.  Pulv.  Rhei.  Pil.  Hydrarg.  a.  a.  gr.  iv.  M.  ft.  Pil.  ij.  nocte  sumendus. 

R.  Haust.  Aper.  ut  antea,  mane  post  pil. 

R.  Sp.  ./Ether  Sulph.  co.  ^ij.  Liq.  Arnmon.  Acet.  ijij.  Aq.  Rosae  ^iv.  Aq.  ad  §xvj.  M.  ft. 
Lotio  capite  continue  admovend. 

15th. — Much  better,  having  passed  a  tranquil  night;  he  rose  without  much  effort,  and  got 
down  into  the  dining-room,  about  ten  o'clock.  Rested  on  the  sofa  for  an  hour ;  and  the  tone 
of  his  mind  was  evidently  more  healthy  and  natural,  as  tie  talked  of  his  future  prospects 
quietly,  and  seemed  quite  collected,  except  as  to  where  he  was,  and  the  hour,  &c. 

Had  the  best  part  of  a  larnb  chop,  and  a  glass  of  bitter  ale,  at  twelve,  having  taken  a 
dose  of  tonic  mixture  at  eleven.  Walked  round  the  garden  with  the  assistance  of  an  arm, 
for  ten  or  twelve  minutes,  then  came  in  and  read  the  newspaper  for  a  short  time,  and  fell 
into  a  natural  sleep  for  half  an  hour;  awoke  without  the  usual  excitement,  his  pulse  count- 
ing 53.  He  was  quiet,  but  cheerful,  and  ate  a  bit  of  boiled  fish,  at  five  o'clock,  and  his 
second  glass  of  ale,  and  after  resting  for  an  hour  on  the  sofa,  he  walked  on  the  common  for 
more  than  a  quarter  of  an  hour  without  feeling  tired.  Had  his  cup  of  cocoa,  and  a  little 
bread  and  butter,  at  eight  o'clock,  and  went  to  bed  at  half-past  nine.  Bowels  irritable. 

16th. — Awoke  with  a  very  bad  headache,  having  had  a  restless  night;  he  was  scarcely 
able  to  sit  up  for  the  hair-dresser  to  shave  him,  after  which  operation  he  lay  down  on  the 
bed,  and  was  some  time  before  he  could  finish  dressing.  His  head  continued  very  ted  with 
what  he  described  to  the  doctor  as  a  "  bumping"  headache,  ate  a  little  meat,  and  had  his  ale, 
at  twelve,  after  which  he  fell  into  a  heavy  sleep  for  an  hour ;  awoke  with  much  less  head- 
ache, but  the  eyes  bright,  and  pupils  dilated,  and  his  countenance  vacant.  He  became  rest- 
less ;  wanted  his  boots,  &c.,  to  go  to  town ;  inquiring  of  the  servants  where  the  omnibus 
went  from,  &c.  For  an  hour  and  a  half,  his  friends  had  great  difficulty  to  keep  him  amused 
and  quiet,  but  as  it. poured  with  rain,  he  could  not  then  get  out.  He  had  some  fish  at  five, 
and  the  weather  clearing,  he  went  for  an  hour's  drive,  when  he  got  quite  cheerful,  and  en- 
joyed it :  after  he  came  home  again,  became  restless,  and  soon  retired  to  bed. 

17th. — I  found  him  very  drowsy,  complaining  of  great  pain  in  his  head,  which  was  hot, 
and  the  face  flushed:  pulse  40,  full  and  laboring,  occasionally  slightly  intermittent.  It  ap- 
peared to  me  very  clear  that  we  had  now  to  contend  again  with  the  old  mischief,  and  that 
from  an  anaemic  state  of  brain,  we  had  now  an  hyperaamic  condition.  I  recommended  the 
application  of  forty  leeches,  and  the  head  to  be  shaved.' 

R.  Spirit  Terebinth,  ^j.  Mist.  Cath.  Com.  £iv.  M.  ft.  Mist,  pro  Enema. 


476  HUMAN   BRAIN. 

R.  Hydrarg.  Prot.  Chlor.  gr.  ij.  sit.  pulv.  3Uis-  horis  sumend.  Mitte  viij.  Enema  Tere- 
binth. 

He  was  so  rftstless,  that  not  more  than  fifteen  leeches  were  applied. 

18th. — Impossible  to  rouse  him,  either  for  his  breakfast  or  the  hair-dresser:  he  had  been 
restless  and  wandering  all  night,  with  occasionally  heavy  sleep.  His  bowels  had  been  very 
inactive,  although  pills,  &c.  had  been  given  at  night.  He  remained  in  that  drowsy  state  till 
two  o'clock,  when  he  slightly  improved ;  at  three  o'clock  a  dose  of  Croton  oil,  Tr^ij.  was 
given,  and  another  at  six  o'clock,  after  which  the  bowels  were  relieved,  and  he  rallied  won- 
derfully, his  hands  and  feet  becoming  warm,  and  his  pulse  rising  to  60.  Was  pot  able  to 
get  up  at  all. 

R.  Hydrarg.  Prot.  Chlor.  gr.  iij.  Sacchar.  gr.  v.  01.  Croton.  TT^ij.  M.  pro  pulv.  statim  sumend. 
1  P/M.  et  repet.  post  horas  tres.  Mitte  ij. 

19th. — Awoke  without  much  pain,  having  slept  tolerably,  but  his  ideas  confused,  and  great 
exhaustion  all  day.  Slept  heavily,  and  had  no  appetite,  and  about  six  o'clock  in  the  evening 
had  most  violent  pain,  more  particularly  in  the  right  side  of  the  head,  which  lasted  till  twelve 
at  night,  when  he  became  exhausted,  and  fell  into  a  good  sleep  for  an  hour  or  two  ;  was 
quite  conscious  and  collected  while  in  the  violent  pain,  but  became  wandering  and  confused 
when  it  subsided.  Bowels  inactive. 

20th. — Awoke  from  his  sleep  so  exhausted  he  could  hardly  speak,  but  perfectly  sensible. 
In  the  afternoon,  took  some  pills,  after  which  his  bowels  were  much  relieved ;  but  he  was 
so  weak  he  could  not  stand,  even  with  the  assistance  of  two  persons,  nor  take  any  nourish- 
ment. Not  much  pain  in  his  head,  and  he  was  evidently  suffering  from  exhaustion. 

R.  Ol.  Croton  TT^ij.  Ext.  Coloc.  co.  gr.  viij.  M.  ft.  Pil.  ij.  statim  sumend.  (11  A.  M.) 

R.  Potass.  Bicarb,  gij.  Aq.  Distillat.  ^viij.  M.  ft.  Mistur.  Alkalin. 

R.  Acid  Citric  £)iv.  Aq.  viij.  M.  ft.  Mistur.  Acid.  Cap.  Coch.  amp.  duo  sing,  dosis.  Mistur. 
Alkalin.  2dis<  vel  3tiis-  horis  in  actu  effervescentiae. 

R.  Liq.  Opii  sedat.  TT^xx.  Conf.  Arom.  £j.  Aq.  Cinnam.  £vij.  M.  ft.  Haust.  Signa.  the 
soothing  draught.  Mitte  ij.  One  taken  early  in  the  morning  of  the  21st. 

2 1st. — Had  been  restless  from  the  irritability  of  his  bowels,  but  slept  heavily  towards 
morning,  and  continued  in  a  heavy,  drowsy  state,  but  conscious  (though  unable  to  speak) 
when  he  was  roused  to  take  nourishment,  or  medicine,  which  he  swallowed  at  all  times  with 
difficulty,  and  sometimes  could  not  swallow  at  all. 

8  P.  M. — I  found  him  sleeping,  and  spoke  to  him,  and  with  difficulty  got  him  to  put  out  his 
tongue:  he  did  not  open  his  eyes,  but  on  my  asking  him  if  he  knew  me,  he  nodded  his  head, 
evidently  recognizing  my  voice.  About  an  hour  afterwards,  he  was  unconscious,  and  I  could 
not  rouse  him  at  all :  head  rather  hot ;  pulse  40,  soft  and  feeble. 

We  agreed  that  he  would  not  bear  any  kind  of  depletion,  but  that  we  would  try  and  stimu- 
late the  kidneys. 

R.  Ammon.  Sesquicarb.  gss.  Tinct.  Cardamom,  co.  ^ss.  Syrup  Aurant.  giij.  Sp.  Myrist. 
gj.  Aq.  Anethi.  ^iv.  M.  Capt.  Coch.  j.  amp.  omni  hora.  Commenced  about  mid-day,  and 
continued  till  6£  p.  M. 

R.  Acet.  Lyttoe  ^j.  pro  capitis  applicatione. 

R.  Potassse  Bicarb.  g\ss.  Sp.  Junip.  co.  |;ss.  Tinct.  Lyttae  !jj.  Syrup  Aurant.  £ij.  Aqua; 
§viij.  M.  Capt.  Coch.  amp.  duo  statim  et  3tu-  vel  4tl-  q.  q.  hora  sumend.; 

22d. — Passed  a  tranquil,  heavy  night,  without  much  natural  sleep,  but  was  somewhat  better 
in  the  morning:  bowels  quite  inactive:  towards  the  middle  of  the  day,  roused  a  little,  took 
his  medicine,  but  very  little  nourishment  during  the  day,  and  the  face  became  hectic  on  the 
cheeks.  The  application  of  tinct.  lyttje  took  a  slight  effect  on  the  forehead,  but  none  on  the 
head.  Very  drowsy,  but  sensible  when  asked  a  question,  although  hardly  able  to  articulate 
an  answer. 

7  o'clock. — Pulse  50,  yawned  and  shuddered  a  good  deal,  moving  his  arms  upwards,  and 
grasping  anything  within  his  immediate  reach.  Bowels  still  inactive.  Became  still  more 
restless,  with  the  hands  moving  constantly  towards  the  head,  breathed  with  difficulty,  and 
between  11  and  12  at  night  had  a  troublesome  cough,  with  difficulty  of  breathing.  Pulse 
low  and  fluttering,  and  was  certainly  unconscious:  passed  a  tolerable  night,  alternately  rest- 
less and  heavy ;  took  half  a  cup  of  beef-tea,  in  spoonfuls ;  but  the  pulse  rather  better  on 
Wednesday  morning. 

23d. — Pulse  55;  face  still  red,  but  did  not  complain  (when  asked)  of  pain,  anywhere,  ex- 
cept the  right  hand;  continued  tranquil,  and  conscious  when  spoken  to. 

2  o'clock. — Pulse  60;  remained  in  a  complete  stupor,  and  without  action  of  the  bowels. 

10  o'clock. — Had  a  simple  enema,  which  had  a  moderate  effect,  and  relapsed  into  the 
game  state  in  which  he  has  remained  all  night.  He  has  taken  a  few  spoonfuls  of  beef  tea, 
and  his  stimulant  medicine,  as  ordered.  His  right  hand  is  rather  swollen,  but  does  not  seem 
in  so  much  pain  as  yesterday.  His  eyes  have  but  once  been  open  since  Sunday. 

24th. — Pulse  48;  comatose  all  day. 


HYPERTROPHY   OF   THE   BRAIN.  477 

25th. — At  2  A.  at.  this  poor  sufferer  was  released,  after  a  most  severe  struggle. 

Post-mortem,  28  hours  after  death,  temperature  60 : — 

External  appearance. — Ecchymosis  from  gravitation  on  the  posterior  part  of  the  head,  neck, 
and  body,  generally :  the  blood-vessels  of  the  scalp  not  particularly  full. 

Internal  appearance. — Vessels  of  dura  mater  very  full ;  bled  freely  after  tearing  off  the  skull 
— and  the  skull  itself  rather  thin  and  vascular ;  convolutions  flattened  by  pressure  of  the  skull  j 
veins  of  pia  mater  full ;  brain  generally  full  of  blood  ;  cortical  substance  rather  darker  than 
usual,  but  not  inflamed ;  all  the  ventricles  very  much  dilated,  especially  the  descending  cor- 
nua;  fifth  ventricle  also  very  large,  containing  nearly  a  drachm  of  fluid;  section  on  a  level 
with  the  corpus  callosum  natural.  On  making  an  incision  into  the  right  hemisphere,  on  a 
level  with  the  upper  part  of  corpus  striatum,  a  difference  in  the  color  presented  itself,  in  the 
medullary  substance;  this  was  a  diffused  yellowish  stain — the  texture  softened;  on  slicing 
the  brain  a  little  further,  and  dissecting  the  whole  carefully,  it  proved  to  be  ramollissement^ 
of  the  medullary  substance  surrounding  a  distinct  fungoid  tumor.  The  softened  brain  was 
about  the  sixth  of  an  inch  in  depth,  and  was  of  a  reddish  color  as  it  approached  the  tumor. 
The  tumor  was  the  size  of  a  pullet's  egg,  nearly  circular  in  form,  medullary  fungus  in  tex- 
ture, contained  in  a  distinct  cyst.  It  was  situated  in  the  medullary  substance  of  the  right 
hemisphere  to  the  outer  side  of  the  corpus  striatum,  and  to  the  inner  side,  and  in  contact 
with  the  convolutions  of  the  Insula  of  Reil  in  the  fissura  Sylvii.  Thoracic  and  abdominal 
viscera  healthy. 

Hypertrophy  of  the  Brain. — It  is  now  a  well-established  fact  that  the 
brain,  like  the  heart  and  other  organs  of  the  body,  occasionally  becomes 
hypertrophied.  The  neurine  which  composes  it  is  actually  increased  in 
quantity  ;  but  this  increase  is  not  so  clearly  the  effect  of  the  undue  ex- 
ercise of  the  organ  as  the  hypertrophy  of  the  heart.  When  the  heart  is 
hypertrophied  it  can  generally  be  accounted  for  by  its  having  had  double 
duty  to  perform  in  consequence  of  some  obstruction  either  at  the  com- 
mencement or  in  the  course  of  the  arteries,  or  some  other  circumstance 
which  has  called  its  powers  unusually  into  play,  such  as  a  defective  con- 
dition of  the  valves.  But  this  is  not  so  clearly  proved  with  regard  to 
the  brain.  Still  it  must  be  allowed  that  as  the  disease  generally  occurs 
in  childhood  while  the  brain  is  still  growing,  and  there  has  been  a  cer- 
tain degree  of  intellectual  precocity  in  some  of  the  cases  on  record,  there 
is  sufficient  evidence  to  use  as  an  argument  against  the  early  stimulation 
of  the  brain. 

There  can  be  no  doubt  that  many  a  child  has  been  sacrificed  in  early 
youth  to  the  pride  of  parents,  who,  delighted  with  the  intellectual  activity 
of  their  children,  have  striven  to  make  them  prodigies  of  learning.  But 
in  these  cases  of  early  and  undue  employment  of  the  brain,  inflamma- 
tion of  the  hemispherical  ganglion,  or  of  the  lining  membrane  of  the 
ventricles  with  serous  effusion,  has  usually  been  the  cause  of  either  a 
fatal  issue  or  of  subsequent  mental  imbecility.  The  late  Mr.  Deville 
related  to  me  an  interesting  case  of  this  kind.  An  extremely  intelligent 
boy,  of  about  twelve  years  of  age,  was  brought  to  him  for  phrenological 
examination  by  a  parent  who  was  very  proud  of  the  intellectual  endow- 
ments of  his  child.  Mr.  Deville  gave  his  opinion  of  the  boy's  character, 
at  the  same  time  cautioning  the  father  of  the  dangerous  course  he  was 
pursuing.  But  the  father's  reply  was,  "  all  that  other  boys  considered 
labor  and  hard  study  are  mere  child's  play  to  him  ;  that  his  studies  could 
not  be  hurting  him,  he  enjoyed  them  so  much."  Again  Mr.  Deville 
endeavored  to  save  the  child,  but  the  father  would  not  attend  to  the 
warning.  Two  years  from  that  time  the  father  again  called  on  Mr.  De- 
ville, and  in  reply  to  his  inquiries  after  his  child  the  father  burst  into 
tears — his  child  was  an  idiot. 


478  HUMAN   BRAIN. 

Hypertrophy  of  the  brain  is  easily  recognized  after  death,  in  conse- 
quence of  its  immediately  bulging  out  the  dura  mater  as  soon  as  the 
skull-cap  is  removed.  The  texture  of  the  brain  is  so  extremely  elastic 
and  compressible  that  as  soon  as  the  box  is  opened  it  rises  up,  showing 
most  unequivocally  that  it  is  too  large  for  its  containing  cavity.  The 
hypertrophied  brain  is  always  unnaturally  hard,  and  the  tubular  structure 
almost  bloodless.  The  blood-vessels  have  evidently  been  so  compressed 
that  their  cavities  are  at  last  obliterated.  It  is  not  certain  that  we  can 
account  for  the  hardness  by  the  same  physical  cause,  but  it  seems  most 
probable,  notwithstanding  the  apparently  rapid  course  which  the  disease 
pursues  in  some  cases,  that  the  hardness  is  not  the  result  of  inflamma- 
tory action,  but  of  the  pressure.  Dr.  Sims,  from  whose  paper  I  have 
quoted  a  case,  considers  that  there  are  two  kinds  of  hypertrophy,  the 
one  consisting  simply  of  a  mere  addition  of  similar  particles,  the  other 
resulting  from  a  change  in  texture.  I  think  it  very  doubtful  if  they  are 
not  one  and  the  same  disease.  Induration  of  the  brain  does  take  place 
quite  independent  of  hypertrophy,  where  there  is  no  pressure  to  account 
for  it,  as  will  be  mentioned  further  on.  It  appears  that  this  disease  was 
first  distinctly  recognized  by  the  celebrated  Laennec.  It  has  been  as- 
serted that  it  was  known  to  Morgagni,  but  I  see  no  reason  for  this  opi- 
nion. The  only  observations  of  this  famous  observer  which  could 
countenance  this  idea  are  in  his  fourth  epistle,  in  which  he  treats  of 
serous  apoplexy.  The  existence  of  this  disease  was  scarcely  allowed 
at  all  at  that  time,  so  that  he  was  obliged  to  use  every  argument  he  could 
to  prove  it.  In  this  letter,  when  endeavoring  to  account  for  apoplectic 
symptoms  being  produced  by  a  very  small  effusion,  he  says,  u  This  must 
be  accounted  for  from  the  bulk  of  the  cerebrum  or  cerebellum  being 
disproportioned  to  the  bulk  of  the  cranium  ;  and  as  this  want  of  sym- 
metry frequently  happens  betwixt  other  parts,  why  may  it  not  sometimes 
happen  betwixt  these  also  ?"  He  says  he  was  led  to  this  opinion  by 
u  observing  in  some,  how  very  deep  a  hollow  was  formed  by  the  vessels 
that  are  prominent  in  the  dura  mater."  He  makes  no  remark  which 
could  lead  one  to  believe  that  he  had  ever  met  with  a  case  of  true  hyper- 
trophy. His  observations  are  so  accurate  and  his  perception  so  acute 
that  he  would  not  have  passed  it  over  if  he  had  seen  it.  The  first  ob- 
servations of  Laennec  occur  in  some  reflections  on  hydrocephalus,  added 
to  a  memoir  of  M.  Matthay,  of  Geneva.  He  says,*  that  "  there  is  a 
third  alteration  which  produces  the  same  effects,  the  brain  being  in  some 
instances  too  large  for  the  skull,  as  was  remarked  by  Morgagni.  M. 
Jadelot  has  told  me  that  he  has  observed  the  same  thing  in  infants,  and 
has  remarked  that  a  great  number  of  those  who  die  of  internal  hydroce- 
phalus do  not  show  anything  else  on  opening  the  body  besides  this  dis- 
proportion of  volume  between  the  brain  and  cranium.  It  has  also 
happened  that  I  have  seen  some  patients  that  I  have  regarded  as  attacked 
with  internal  hydrocephalus,  and  who  on  opening  the  bodies  have  pre- 
sented but  a  small  quantity  of  wrater  in  the  ventricles,  whilst  the  convo- 
lutions of  the  brain  strongly  flattened  showed  that  this  viscus  had  under- 
gone compression,  which  could  only  be  attributed  to  too  great  volume, 
and  consequently  to  a  too  active  nutrition  of  the  cerebral  mass." 

*  Journal  de  Medecine  de  MM.  Corvisart,  Leroux  et  Boyer,  torn.  ii.  p.  669.  Neur.  1806. 


HYPERTROPHY   OF   THE   BRAIN.  479 

In  1823,  he  again  treats  of  this  disease,  having  evidently  seen  several 
cases  in  the  meantime.  The  following  description,  which  is  in  his  own 
\vords,  gives  so  complete  an  account  of  the  disease,  that  it  is  impossible 
to  add  much  to  it : — "  This  alteration,  comparatively  common  in  infants, 
is  rare  in  the  adult.  It  is  characterized  by  very  great  firmness  of  the 
cerebral  substance,  by  a  considerable  widening  of  the  cerebral  convolu- 
tions of  the  brain,  although  the  ventricles  contain  little  or  no  serum.  It 
may  be  developed  slowly,  but  more  frequently  it  is  an  acute  affection, 
the  symptoms  of  which  are  very  analogous  to  those  of  hydrocephalus. 
It  appears  to  be  the  result  neither  of  inflammation  nor  of  the  excess  of 
action  of  this  organ,  for  it  is  not  more  common  in  men  of  study  than  in 
others  ;  and  it  is  rare  that  inflammation  is  even  occasionally  the  cause 
of  hypertrophy,  unless  it  be  in  that  of  the  tonsil  glands.  In  almost  all 
other  organs,  prolonged  frequency  or  repeated  inflammation  ends  by 
producing  atrophy." 

M.  Scoutteten  was  the  next  who  detected  any  cases  of  this  disease. 
His  observations  are  published  in  the  7th  volume  of  the  Archives 
General  de  Med.,  Jan.  1825.  He  gives  the  case  of  a  child  five  years 
and  a  half  old.  His  head  was  very  large,  but  his  intellect  below  par ; 
he  died  after  sixteen  days'  illness ;  he  only  entirely  lost  his  conscious- 
ness on  the  day  of'his  death.  The  post-mortem  appearances  were  those 
of  hypertrophy. 

M.  Dance*  in  1828  related  four  interesting  cases  of  this  disease,  all 
occurring  in  adults  from  the  age  of  twenty-four  to  thirty  years. 

The  first  case  was  a  young  man  of  twenty-six  years  of  age,  who  re- 
ceived a  blow  at  the  age  of  fourteen  with  a  hatchet  on  the  vertex  of 
the  head,  just  twelve  years  before  his  death;  he  was  not  stunned  by  the 
blow,  but  he  was  attacked  with  delirium,  and  remained  seven  months 
ill ;  from  this  time  till  about  six  weeks  before  his  death  he  suffered  but 
little  in  his  head,  except  from  cold,  any  exposure  to  which  gave  him 
pain.  Previous  to  his  death  his  principal  symptoms  were  violent  parox- 
ysms of  pain  and  a  very  slow  pulse.  There  was  but  little  disturbance 
of  intellect,  or  sensation.  The  appearance  of  the  brain  was  most  striking. 
— "  All  the  convolutions,  particularly  at  the  upper  part,  had  increased 
to  double  their  normal  size,  they  were  flattened,  and  so  jammed  one 
•  against  the  other,  that  it  was  difficult  to  perceive  the  separations  between 
them,  so  that  the  surface  of  the  brain  presented  a  plain  surface,  without 
elevation  or  depression.  The  arachnoid  and  pia  mater  were  firmly  ad- 
herent, as  was  the  pia  mater  to  the  convolutions,  and  these  membranes 
seemed  thinner  than  natural  ;  they  were  not  at  all  injected,  and  were  so 
glued  together  that  they  could  not  be  separated  without  tearing  them. 
The  whole  cerebral  substance  looked  much  like  the  white  of  a  hard- 
boiled  egg;  its  weight  and  density  were  considerable,  it  did  not  fall  to 
pieces,  and  resisted  under  pressure.  When  drawn  out,  it  elongated 
considerably,  and  then  resumed  its  shape,  like  an  elastic  body;  no  trace 
of  vessels,  no  mottled  appearance,  nor  no  red  hue,  was  to  be  seen  ;  on 
the  contrary,  the  cortical  portion  appeared  paler,  the  medullary  whiter, 
than  usual.  The  ventricles  contained  no  fluid  ;  their  cavities  appeared 

*  Observations  pour  servir  a  1'Histoire  de  1'Hypertrophie  du  Cerveau,  par  la  Donee,  Rep. 
General  d'Anat.  de  Physiol.  et  du  Pathol.,  p.  197. 


480  HUMAN    BRAIN. 

but  of  half  their  usual  size,  from  the  encroachment  of  their  walls.  When 
the  cerebral  mass  was  removed,  there  did  not  appear  to  be  a  drop  of 
fluid  in  the  cranial  cavity,  the  surface  of  the  arachnoid  being  as  dry  as 
parchment ;  the  pons  Varolii  was  slightly  in  the  same  state  as  the  brain  ; 
but  the  cerebellum  and  medulla  oblongata  presented  no  abnormal  ap- 
pearances. The  other  organs  were  quite  healthy."* 

In  the  second  case,  the  subject  of  it,  twenty-four  years  of  age,  was 
slightly  imbecile  in  intellect ;  he  suffered  from  pain  in  his  head,  but  not 
from  any  convulsions,  previous  to  his  admission  into  the  hospital.  On 
the  sixth  day  after  his  entrance  there,  he  was  seized  with  convulsions, 
stiffness  of  the  limbs,  and  grinding  of  the  teeth  ;  after  suffering  from 
several  such  fits,  he  sunk  into  a  comatose  state,  and  with  dilated  pupils 
and  stertorous  breathing,  died. 

The  post-mortem  appearances  were  strikingly  similar  to  the  last.  The 
cerebellum  was  healthy  in  every  respect. 

In  the  third  case,  the  intellect  of  the  patient,  who  was  thirty  years  of 
age,  had  been  for  some  months  gradually  giving  way.  A  few  days 
previous  to  death  he  was  found  lying  on  the  ground,  insensible  and 
paralyzed  ;  he  slightly  recovered  his  consciousness,  but  not  to  any  extent. 
The  post-mortem  appearances  were  the  same  as  in  the  two  last  cases. 

The  fourth  case  is  too  interesting  to  abridge. f 

Case  98. — "A  house-painter,  thirty  years  of  age,  of  an  athletic  constitution,  was  taken  to 
the  Hotel  Dieu,  having  epileptiform  paroxysms,  which  recurred  three  or  four  times  in  the 
day. 

"  We  did  not  see  him  till  the  day  after  his  admission ;  he  spoke  with  extreme  slowness 
and  with  remarkable  difficulty,  which  seemed  to  arise  from  want  of  memory,  for  he  sought 
his  answers  for  some  time,  and  repeated  them  again  and  again,  as  if  to  assure  himself  of 
their  exactitude.  He  did  not  understand  all  the  questions  that  were  asked  him,  yet  he 
gave  us  a  history  of  himself,  conformable  in  many  points  to  that  which  we  had  got  from 
his  wife.  His  pulse  was  full  and  rather  quick ;  his  face  red ;  the  skin  hot ;  his  respiration 
was  interrupted  by  involuntary  sighs;  there  was  no  change  in  the  form  of  the  mouth,  nor 
paralysis  of  any  of  the  limbs. 

"For  six  years  previously  he  had  been  subject  to  determination  of  blood  to  the  head;  at 
times  he  was  attacked  by  a  giddiness,  which  lasted  from  three  to  four  minutes ;  he  then  lost 
the  use  of  his  senses  and  became  quite  stupefied.  But  three  years  since  he  fell  from  a  third 
floor,  and  these  fits  became  changed  to  true  epileptic  attacks,  recurring  at  first  at  long  inter- 
vals, but  afterward  following  one  another  more  closely,  so  that  at  this  time  he  had  four  or 
five  fits  a  day.  He  was  habitually  of  a  gloomy,  taciturn  character  ;  he  was  of  a  full  habit, 
and  frequently  complained  of  pain  in  his  head  and  stomach.  Blood-letting  had  always 
calmed  and  lessened  these  attacks ;  spirituous  liquors,  in  which  he  sometimes  indulged, 
always  augmented  his  malady.  On  the  12th  of  March,  three  days  before  his  admittance 
into  the  hospital,  having  drank  two  glasses  of  punch,  he  was  attacked  in  the  night  by  very 
violent  convulsions;  a  physician  was  called,  who  prescribed  twenty  leeches  to  the  epigas- 
trium ;  but  the  patient  was  not  benefited  by  the  application. 

"  At  the  hospital  he  was  bled,  which  seemed  only  to  make  him  worse.  During  the 
night  of  the  16th  he  had  three  fits  in  close  succession,  of  a  true  epileptic  character.  On  the 
morning  of  the  17th  he  had  a  distracted  air,  not  answering  questions ;  soon  became  comatose, 
with  loss  of  sensation  and  motion.  Eyes  closed,  pupils  contracted,  mouth  half  open,  tongue 
raised,  respiration  stertorous,  profuse  perspiration,  pulse  140.  Sometimes  tension  and  stiff- 
ness of  the  limbs,  followed  by  general  collapse,  and  death  at  10  A.  M.  The  post-mortem 
appearances  were  those  of  true  hypertrophy. 

M.  Meriadec  Laennec  was  the  next  who  wrote  on  this  subject ;  but 
his  memoir  was  written  without  being  aware  of  the  existence  of  that  of 
M.  Dance:  he  relates  five  cases,  all  adults. i  In  all  the  cases  there 

*  Op.  cit.,  p.  200.  f  P.  206. 

J  Observ.  pour  servir  THistorie  de  1'Hypertrophie  duCerveau:  Revue  Med.,  torn.  iv.  1818. 


HYPERTROPHY   OF   THE   BRAIN.  481 

were  epileptic  fits  or  epileptiform  convulsions.  In  all,  the  post-mortem 
appearances  were  the  same  ;  all  characteristic  of  hypertrophy  of  the 
brain.  In  three  of  the  cases,  the  patients  had  suffered  from  lead  colic, 
and  were  exposed  to  the  influence  of  lead  at  the  time  of  their  attacks. 

In  the  first  case,  the  patient  32  years  of  age,  the  course  of  the  disease 
was  most  rapid,  the  cerebral  symptoms  only  lasting  ten  days ;  but  the 
usual  post-mortem  appearances  were  found. 

In  the  second,  the  patient,  44  years  of  age,  was  ill  apparently  about 
one  month ;  the  symptoms  were  those  of  cerebritis,  and  the  appearances 
those  belonging  to  hypertrophy;  there  were  hardening  and  flattening  of 
the  convolutions,  and  absence  of  blood  in  the  substance. 

In  the  third  case,  the  patient,  aatat.  43,  had  an  epileptic  fit  on  the  1st 
of  January ;  they  were  repeated  at  intervals  ;  on  the  21st  he  had  several, 
succeeding  each  other  very  closely,  and  he  sank  on  this  day.  The 
post-mortem  appearances  the  same  as  in  the  others. 

In  the  fourth  case,  the  patient,  aatat.  22,  had  an  epileptic  attack  on 
the  30th  of  March,  and  died  on  the  2d  of  April,  having  had  several  fits 
previous  to  her  death. 

In  the  fifth  case,  the  patient,  atat.  13,  was  a  delicate  child  from 
birth  ;  weak  intellect,  but  not  idiotic ;  suffered  in  his  head  for  above  a 
year  previous  to  death. 

M.  Meriadec  Laennec  considers  that  the  rapidity  of  the  course  of  this 
hypertrophy  of  the  brain  allies  it  more  nearly  than  any  other  hypertrophy 
to  the  inflammatory  turgescences. 

Dr.  Sims  published  some  cases  of  hypertrophy  and  atrophy  of  the  brain 
in  the  nineteenth  volume  of  the  Transactions  of  the  Medico-Chirurgi- 
cal  Society.  One  of  these  is  interesting,  from  its  affording  an  instance 
of  very  partial  hypertrophy.  The  disease  is  generally  confined  to  the 
hemispheres  of  the  cerebrum  ;  but  in  this  case  the  corpora  striata,  one 
thalamus,  and  the  tuber  annulare,  were  alone  affected. 

Case  99. — C.  D.,  set.  60,  a  lunatic  for  twenty  years,  with  lucid  intervals;  he  was  ap- 
proaching to  a  state  of  fatuity;  he  complained  much  of  great  weakness  of  the  lower  extre- 
mities ;  he  had  a  carcinomatous  disease  of  the  lower  lip,  which  Mr.  Perry  removed.  The 
wound  looked  well  at  the  time  of  his  death. 

Inspection. — Head. — The  skull  was  remarkably  hard ;  there  was  serous  effusion  between, 
the  membranes,  and  a  large  quantity  in  the  intergyral  spaces.  On  opening  the  ventricles, 
the  corpora  striata  appeared  pressed  much  closer  to  each  other  than  usual.  The  right 
corpus  striatum  was  twice  its  ordinary  size;  the  left  slightly  enlarged.  The  left  thalamus 
was  very  much  enlarged.  The  tuber  annulare  appeared  half  as  large  again  as  usual;  the 
crura  cerebri  were  also  enlarged. 

The  latest  information  regarding  hypertrophy  is  from  the  pen  of  Dr. 
Mauthner,  of  Vienna.*  The  following  account  is  taken  from  an  admi- 
rable review  of  the  work  in  the  British  and  Foreign  Medical  Review, 
vol.  xxi.  p.  387. 

Dr.  Mauthner  weighed  the  brain  of  216  children,  at  all  ages  from 
birth  up  to  the  eighth  year,  during  the  whole  of  which  period  an  increase 
in  its  weight  is  pretty  constantly  going  on. 

"  During  this  time,"  says  he,  u  we  find  a  minimum  of  10  oz.  6  dr. 
rise  to  a  maximum  of  44|  oz.  The  average  weight  begins  with  13J, 

*  Die  Krankheiten  des  Gehirns  und  Riickenmarks  bei  Kindern.  Durch  Krankheitsfalle 
aus  dem  ersten  Kinderspitale  erlautert,  von  Dr.  L.  W.  Mauthner.  Wien,  1844. 

31 


482  .  HUMAN   BRAIN. 

and  rises  to  35.V  oz.  During  the  first  year  it  grows  from  13JL  to  20^,  or 
7  oz. ;  in  the  second,  from  20^  to  25J,  or  5  oz. ;  in  the  third,  from  £5} 
to  32,  or  6|  oz.  ;  and  between  the  fourth  and  eighth  year,  from  32  to 
35J,  or  3|  oz.  Hence  it  appears  that  the  brain  grows  more  rapidly  in 
the  first  year  of  life ;  that  in  the  second  and  third  years  its  increase  is 
still  considerable,  but  that  its  growth  is  slower  after  the  fourth  year.  In 
conclusion  it  may  be  observed,  as  a  remarkable  fact,  that  the  minimum 
weight  usually  occurs  in  cases  of  atrophy  or  phthisis ;  the  maximum  in 
pneumonia,  scarlet  fever,  apoplexy,  and  cerebral  tubercle." — P.  162. 

He  points  out  the  frequent  coincidence  with  enlargements  of  the  thy- 
mus  gland,  of  the  left  ventricle  of  the  heart,  and  of  the  liver  ;  facts  which 
lend  some  support  to  Miinchmeyer's  theory  of  the  connection  of  asthma 
thyinicum  with  hypertrophy  of  the  brain.  He  describes  an  induration 
of  the  brain  in  anatomical  characters  similar  to  hypertrophy  ;  but  in  which 
the  brain  is  not  larger  than  natural.  The  skull  is  smaller,  probably  the 
result  of  excessive  activity  of  the  process  of  ossification  ;  and  hence  the 
pressure  to  which  the  brain  is  subjected.  In  these  cases  the  child  is 
always  deficient  in  intellectual  power,  and  is  frequently  idiotic,  and 
unable  to  walk.  The  head  retains  its  natural  size,  but  the"  sutures  close 
unusually  early,  and  the  parietal  and  occipital  protuberances  are  unusu- 
ally prominent. 

Such  children  present  none  of  those  indications  of  rachitis  which  so 
often  coincide  with  hypertrophy  of  the  brain  ;  but  the  lower  animal  life 
thrives  at  the  expense  of  the  higher;  the  skin  is  firm,  and  the  body  fat 
and  ruddy;  the  muscles  and  bones  strong,  the  constitution  robust,  and 
the  appetite  craving. 

It  further  appears,  from  a  minute  examination  of  the  condition  of  the 
brain  in  these  cases,  that  its  weight  is,  to  a  great  degree,  dependent  on 
the  quantity  of  blood  which  it  contains. 

"  In  detailing  the  symptoms  that  ordinarily  attend  hypertrophy  of  the 
brain,  M.  Mauthner  distinguishes  the  passive  from  the  active  form  of  the 
affection. 

"In  passive  hypertrophy,  the  cranium  early  presents  a  striking  devia- 
tion from  its  natural  appearance,  in  the  enlargement  and  globular  promi- 
nence of  the  occiput.  The  parietal  protuberances  subsequently  project, 
the  coronal  and  sagittal  sutures  continue  open  in  the  ninth  or  even  in 
the  twelfth  month,  and  the  fontanelles  remain  unclosed  for  a  much  longer 
time  than  natural ;  the  growth  of  hair  is  scanty,  and  the  veins  of  the 
scalp  are  much  injected.  Children  in  this  state  sleep  much,  though 
they  are  easily  startled  ;  they  sweat  much  about  the  head  ;  and  when  in 
a  sitting  posture,  the  head  drops  forward  by  its  own  weight.  Attacks  of 
crowing  inspiration  occur  when  the  child  cries,  and  not  unfrequently 
end  in,  or  are  accompanied  by,  regular  convulsions,  and  the  severity  and 
frequency  of  these  seizures  are  greatest  during  the  period  of  dentition. 

"  Digestion  is  at  the  same  time  impaired,  and  vomiting  and  diarrhoea 
are  frequent.  By  degrees  the  symptoms  of  pressure  on  the  brain  become 
more  evident,  or  they  are  suddenly  developed,  as  the  result  of  the  super- 
vention of  some  other  disease. 

"  When  hypertrophy  of  the  brain  has  reached  this  stage,  the  skull 
deviates  still  more  from  its  natural  shape:  the  forehead  sometimes  be- 


HYPERTROPHY   OF   THE    BRAIN.  483 

comes  prominent  and  globose  like  the  occiput;  and  while  the  skull  goes 
on  acquiring  an  increased  curvature,  the  region  of  the  temples  continues 
flat,  and  thus  contributes  to  give  to  the  head  the  appearance  of  being 
formed  by  the  union  of  the  segments  of  four  spheres.  During  this  stage 
of  the  affection,  the  preternatural  softening  and  thinning  of  the  cranial 
bones,  corresponding  to  the  prominences  of  the  convolutions,  are  dis- 
tinctly perceptible,  especially  at  the  occiput.  The  functions  of  the 
brain  become  now  much  disturbed ;  headache,  giddiness,  impairments 
of  muscular  power,  and  loss  of  memory,  occur;  the  child  grows  sullen, 
peevish,  sleepless,  whimpers  continually,  and  rolls  the  head  constantly 
from  side  to  side.  At  the  same  time  it  becomes  choked  with  phlegm, 
while  the  skin  becomes  every  day  more  flabby,  the  muscles  shrink,  the 
bones  grow  soft,  and  the  muscular  power  rapidly  diminishes. 

"  Hence  these  children  lie  usually  on  their  back,  breathing  with  habi- 
tual wheezing,  and  suffering  from  constant  dyspnoea,  with  occasional 
asthmatic  seizures,  such  as  have  been  already  described.  When  in  this 
condition,  slight  causes  suffice  to  produce  a  general  excitement  of  the 
vascular  system,  and  to  excite  diseased  action  in  other  parts,  which  ren- 
der still  more  obvious  the  influence  of  the  hypertrophy  on  the  nervous 
system  generally.  If  the  child  happen  to  catch  a  slight  cold,  attacks  of 
convulsive  cough,  or  of  asthma,  occur  in  consequence,  or  convulsions 
come  on,  which  terminate  life  in  a  few  days." — P.  174. 

"  Such,"  says  the  reviewer  of  M.  Mauthner,  "  is  the  course  usually 
run  by  this  affection  ;  but  its  symptoms  differ  when,  as  is  sometimes  the 
case,  the  hypertrophy  is  partial,  or  when  the  disease  assumes  the  active 
form,  or  that  in  which  the  walls  of  the  skull,  owing  to  the  energy  of 
the  process  of  ossification,  do  not  expand  in  proportion  to  the  rapid 
growth  of  the  brain.  Its  symptoms  then  are  usually  those  of  active 
cerebral  disease; — the  result  of  compression  of  the  brain,  and  its  con- 
sequent congestion." 

In  the  chapter  on  chronic  hydrocephalus,  the  diagnosis  between  that 
disease  and  hypertrophy  of  the  brain  is  stated  at  great  length.  The 
chief  differences  insisted  on  by  M.  Mauthner  are  thus  thrown  into  a 
table  by  the  reviewer  :— 

Hypertrophy  of  the  Brain.  Chronic  Hydrocephaluis. 

1.  The  posterior  part  of  the  skull  first  pre-         1.  The  forehead  is  the  first  part  to  present 
sents  an  unnatural  prominence.  unnatural  prominence  ;  the  altered  direction 

of  the  eyes  and  the  very  great  width  of  the 
sutures  and  fontanelles  are  likewise  charac- 
teristic. 

2.  Children  lie  horizontally,  or  throw  the         2.  Children  He  on  the  belly,  with  the  head 
head  back.  lower  than  the  rest  of  the  body,  burying  the 

face  in  the  pillow. 

3.  Face  puffy,  eyes  inexpressive  and  star-         3.  Countenance  withered,  having  expres- 
ing ;  mouth  half  open.  sion  of  premature  old  age. 

4.  Functional  disturbance  comes  on  very         4.  Functional  disturbance  occurs  early,  and 
gradually ;  not  before  the  period  of  dentition     involves  the  cerebrum  from  the  very  begin- 
or  weaning;    and  consists,  at  first,  in  affec-     ning. 

tion  of  the  respiratory  apparatus,  difficulty  of 
breathing,  and  attacks  of  apnoaa. 

5.  Patients  fat  and  leucophlegmatic.  5.  Patient  ill-nourished,  subject  to  rickets 

and  tabes  mesenterica. 


484  HUMAN   BRAIN. 

Dr.  Mauthner*  has  pointed  out  a  peculiar  form  of  induration  of  the 
brain  occurring  in  children  who  have  died  of  marasmus.  It  consists  of 
a  partial  induration  of  the  organ,  and  though  often  associated  with  dimi- 
nution in  the  size  and  weight  of  the  organ,  is  sometimes  met  with  inde- 
pendent of  any  alteration  of  its  volume.  He  regards  it  as  a  result  of  a 
state  of  congestion  or  inflammation ;  but  the  symptoms  by  which  it  is 
attended  are  very  obscure,  consisting  in  convulsions,  torpor,  and  very 
rapid  emaciation.  The  centrum  ovale  and  the  walls  of  the  lateral  ven- 
tricles, especially  at  the  anterior  or  posterior  horn,  are  its  most  frequent 
seats,  and  it  is  sometimes  remarkably  evident  when  it  affects  the  tania 
semicircularis.  The  indurated  portion  usually  has  an  elongated  form, 
is  distinguishable  by  the  gray  color  of  the  cerebral  substance,  but  espe- 
cially by  its  cartilaginous  hardness.  The  form  of  induration  of  the 
brain,  of  which  Dr.  Mauthner  relates  three  instances,  has,  to  the  best  of 
my  knowledge,  never  been  noticed  by  any  other  writer.  It  is,  there- 
fore, worthy  of  mention,  though,  at  present,  little  more  than  a  patholo- 
gical curiosity. 

The  treatment  of  hypertrophy  of  the  brain  necessarily  differs  according 
to  the  circumstances  under  which  it  occurs.  In  that  form  which  is  con- 
nected with  rickets,  absorbents  with  rhubarb  and  preparations  of  iron, 
and  a  properly-regulated  diet  continued  for  months,  are  often  very  use- 
ful. Cold  sponging  of  the  surface  is  frequently  of  service,  but  in  con- 
sequence of  the  tendency  to  perspiration  about  the  head,  care  should  be 
taken  not  to  leave  it  quite  bare ;  but  it  should  be  constantly  covered 
with  a  light  cap.  In  the  other  form  of  the  disease,  whatever  might 
tend  to  excite  the  brain  must  be  avoided,  while  the  long-continued  use 
of  the  iodide  of  potassium  has  been  found  beneficial.  Warm  baths  and 
the  occasional  application  of  the  moxa,  and  blisters  to  the  back  of  the 
neck,  have  likewise  been  of  service. 

*  British  and  Foreign  Medical  Review,  loc.  cit.,  vol.  xxi.  p.  390. 


. 


INDEX. 


COMPARATIVE  ANATOMY  AND  PHYSIOLOGY  OF  BRAIN. 


A. 

Ai,  or  three-toothed  sloth,  122 

Accessory,  spinal,  239 

Acrita,  of  MacLeay,  51 

Agouti,  118,  119 

Alcock,  Dr.  B.,  root  of  fifth  pair,  184,  236 

Alimentary  canal,  its  relation  to  the  nervous 
system,  59 

Amphibia,  82,  93 

Analysis,  chemical,  of  brain,  38 

Anastomosis  of  nerves,  41,  42 

Animals  classified  according  to  nervous  sys- 
tem, 51 

Animal  kingdom,  divisions,  51,  52 

lowest  form,  51,  59,  63 

simply  nutrient,  59 

Animalcule,  the  wheel,  63 

Ant-eater,  122 

Antennae,  nerves  of,  68 

Ape's  brain,  108,  111,  116,  117,  119,  122, 125 

cerebral  vessels,  129 

Aqueduct,  Sylvii,  foetus  and  fish,  87,  88 

Arabians,  their  physiology  of  the  nerves,  58 

Arachnoid  tunic,  133,  136,  137,  143, 165 

Arbor  vitae,  203,  210 

Area  germinativa,  247 

Aristotle's  physiology,  56 

Arms  and  stomach,  earliest  animal  form,  51, 
59,  64,  71,  77 

Arnold,  F.,  nerves  of  dura  mater,  136,  143 

Arteries  of  brain,  241—242 

Arteries,  spinal,  142,  242 

vertebral,  126—128,  135,  138,  159,  242 

Articulata,  51,  59,  61,  67,  70,  71,  82 

spinal  ganglia  of,  181 

Arsakay,  encephalon,  36 

Ascaris,  simple  nervous  system,  52 

Ascidia  mammillata,  64 

Atrophy,  senile,  of  brain,  39 

Axis  cylinders,  40—43,  48,  49 

B. 

Baboon,  carotids,  126 
Badger,  cerebral  vessels,  129 
Baillarger,  cortical  substance,  205 
Basilar  artery,  127 
Beaver,  cerebral  vessels,  129 
Beclard,  ganglionic  nerves,  58 
Bell,  Sir  C.,  decussation  of  the  spinal  columns, 

187,  195,  198,  202 
fifth  pair,  188 


Bell,  nerves  of  sensation,  260 

physiology  of  the  brain,  41,  51,  61,  74 

roots  of  spinal  nerves,  172,  178,  189,  202 

Bellingeri,  roots  of  spinal  nerves,  174 
Bennet,  foetal  brain,  36 
Berenger,  gray  matter,  34 
Bichat,  arachnoid,  136—137 

physiology  of  brain,  57 

foramen  of,  168 

— - -  ganglionic  nerves,  59 

Bidder,  cerebro-spinal  system,  46,  47 

Bird,  Dr.  G.,  excretion  of  phosphorus,  45,  46 

Birds'  brain,  82,  95,  96,  97, 119,  206, 220,  223, 

225,250,251,262 
Bischoff,  foetal  brain,  247 

spinal  nerves,  176 

Blainville,  nerves,  230 
Blane,  reflex  functions,  74 
Blumenbach,  ganglionic  nerves,  58 
Bouillaud,  cerebellum,  193 
Bowman,  axis  cylinder,  40 

and  Todd,  43,  262 

Brain  alters  its  form  during  life,  266 

base  of,  114,  156,  158 

convolutions,  118;  119—125,  159—163 

cortical  substance,  55,  164 — 168  ; 

earliest  development  of,  77,  78,  79,  82 

how  to  remove  it  from  skull,  141 

instrument  of  mind,  258,  265,  266 

in  mammalia,  97 

movements  of,  138 

progressive  development  of,  82,  246 — 256 

its  relation  to  generative  process,  98, 260, 

262 

series  of  ganglia,  55,  56 

size  in  insects,  69,  76 

system,  57 

four  ganglia,  67 

vertical  section,  157,  197 

wastes,  39,  45,  141,  145,  267 

Brain  and  nervous  system  of, 

Agouti,  118—120 

Ai,  122 

Amphibia,  82,  93 

Ant-eater,  122 

Ape,  108,  111,  116,  117,  119,  122—125 

Asterias,  53 

Baboon,  116,  124 

Badger,  111,  122 

Bat,  116,  119,  122 

Bear,  111,  115,  120,  121,  122,  125 


486 


INDEX. 


Brain  and  nervous  system  of, 

Beaver,  99,  100,  117,  120 

Boar,  125 

Blackbird,  95 

Butterfly,  77,  78,  83 

Buzzard,  95 

Calf,  108,  129,  184,239,249 

Canary,  96 

Carnivora,  111,  113,  115,  116,  117 

Carp,  89,  103,  223,  255 

optic  nerve  of,  232 

Caterpillar,  77 

Cat,  40,  47,  108, 115, 121, 122, 125, 129, 
183 

embryo  of,  248 

Cephalopoda,  79—81 
Centipede,  68 
Cheetah,  119 
Cheiroptera,  116,  119 
Chimpanzee,  116,  124 
Chilognatha,  68 
Civet,  121 
Coati,  121 
Cod,  35 

optic  nerve  of,  232,  233 

Conchifera,  62,  65 
Coney,  122 
Corals,  62 
Crab,  75 
Crocodile,  95 

Crow,  95 

Cuckoo,  95 
Cuttle-fish,  79—80 

Cymothea,  67 

Dog,  116,  121,  125,230,263 

Dolphin,  108,  117 

Duck,  95,  96 

Edentata,  104 

Eel,  83,  85,  91,93 

Egg,  53 

Elephant,  108—112,  119, 122,123,  124, 
129 

its  weight,  145 

Embryo,  83,  87,  159,  161,  246—256 

Ferret,  116,  120,  122,  125,  159 

FcEtus,  128,  247 

Fowl,  95,  96,  264 

Fox,  120—122,  125,  161 

Frog,  47,  93,  206 

Gasteropoda,  65,  66 

Genet,  121 

Giraffe,  129 

Goat,  108,  129 

Goose,  96 

Guinea-pig,  47 

Haddock,  86 

optic  nerve,  232 

Hare,  120,  218,  224 

Hedge-hog,  74,  116,  118 

Horse,  108,  109,  117,  166,  183 

its  weight,  145 

olfactory  nerve,  230 

cerebellum,  &c.,  224,  230, 239, 249 

Hyrax,  119,  122 

Idiot,  39,  160 

Imago,  77—78 
Infant,  205,  226 
Insect,  69 

Insectivora,  116,  119 
Invertebrata,  130 
lulus,  68,  71 


Jrain  and  nervous  system  of, 

Kangaroo,  98—100,  113,  122,  125 

Leopard,  129 

Lemur,  116,  125 

Lymax  ater,  66 

Limpet,  65 

Lion,  115—118,  121,  125 

Lizard,  93,  95,  251 

Lynx,  111,  119 

Magpie,  95 

Mammalia,  82,  97,  116,  117,  206,  248, 

252,  262 

Marsupiata,  98—99,  116,  119 
Marten,  115,  121,  125 
Megatherium,  104 
Molluscs,  51,  57, '60,  62,  65,  67,  92 
Monkey,  108,  116,  117,  118,  122 
Monotremata,  98,  119 
Moth,  77—79 
Mole,  116,  166 

optic  nerve  of,  232,  233 

Mouse,  98 

Myriapoda,  68,  69,  70,  74 
Mammalia,  brain  of,  classified  according 
to  convolutions,  118 — 125;  with  com- 
parative anatomy  of  the  human  brain, 
118—126 
Narwhal,  weight  of  brain,  145 

Necroph.  leophag.,  68 

Negro,  169 

Newt,  93 

Nautilus,  78,  79,  80,  81 

Old  age,  206 

Opossum,  116,  117 

Otter,  125 

Ourang-outang,  117 

Oyster,  64 

power  of  vision,  64 — 65 

Ox,  100,  108,  109,  117,125 

spinal  cord,  189 

cerebellum,  224 

Panther,  121 

Parrot,  96 

Partridge,  96 

Peccary,  125 

Pig,  108,  122,  125 

Pigeon,  95,  96,  263 

Pike,  91 

Polecat,  120,  122 

Polypus,  59,  62 

Porcupine,  103,  120 

Porpoise,  108—114,  116,  117,  125,  183 

Pteropus,  122 

Rabbit,  98,  101,  102,  117 

embryo,  248 

Rat,  98,  118 

Reptiles,  82,  93,  95,  1 12,  250,  251,  255, 
256 

Roebuck,  125 

Rodentia,  98—103,  113,  116,  118,  119, 
129 

Ruminantia,104, 109,  113,  117,121,252 

Salamander,  93,  95 

Sandhopper,  67,  82 

Scolopendra,  71 

Seal,  111,  115,  117,  122,  125 

Sepia,  81,  83 

Shark  (no  air  bag),  92 

Sheep,   104—110,  113,  121,  122,  125, 
166,  183,  189,  202,  224,  230 

Skate,  83,  86,  91—93,  223,  255 


INDEX. 


487 


Brain  and  nervous  system  of, 

Skate,  optic  nerve  of,  232 

Sloth,  104,  122 

Slug,  65 

Snake,  93,  95,  251 

Sparrow,  96 

Spirostrepti,  Spiroboli,  72 

Sponges,  62 

Squirrel,  98,  100,  103,  104,  120 

Stag,  128 

Storks,  96 

Sturgeon,  86 

optic  nerve  of,  233 

Swine,  129 

Starfish,  53,  59,  206,  208 

Talitrus  locusta,  67,  69 

Teeth,  48 

Tiger,  126 

Toad,  93 

Tortoise,  47,  223,  251 

Tunicata,  62 

Turtle,  93,  94,  95,  203 

Vertebrata,  51,  61,  130,  181,  226 

olfactory  nerve  of,  68 

Weazel,  122,  125,  129 

Whale,  115,  122,  125 

weight  of  brain,  145 

Whiting,  86,  103,  223 

Wolf,  121 

Wombat,  98,  99,  122,  125 

Woodpecker,  95 

Wren,  96 
Branchial  sac,  62 

apertures,  246 

Branchiogastric    nerves,  in    the  electric  ray, 

90 
Breschet,  ganglionic  nerve  of,  58,  59 

veins  of  cord,  142 

par  vagum,  185 

Broussais.  ganglionic  nerve,  59 

cerebellum,  193,  261,  262 

Burrows,  cerebro-spinal  fluid,  140 
Budge,  Dr.  J.,  spinal  cord,  177 
Burdach,  membranes  of  cranium,  131,  137 
decussation  of  nerve,  126,  212 

C. 

Calamus  scriptorius,  201 
Calf,  vertebral  arteries  of,  127,  128 
Camel,  carotids  of,  128 
Camper,  optic  ganglia,  88 
Capillaries,  uses  of,  42 
Cardiac  plexus  (Cuttlefish),  80 
Carotids,  126—127,  241 
Carpenter,  cerebral  ganglia,  332 

development  of  ovum,  247 

excito-motory  nerve,  332 

nervous  system,  44,  45,  51,  62,  65 

wasting  of  brain,  45 

Carus,  optic  ganglia,  87 
Cat,  vertebral  arteries  of,  125 
Cauda  equina,  156 
Caudate  vesicles,  43 
Cavernous  sinus,  135 
Cella  cordae  Willisii,  134 
Cells  of  glands,  33,  44 

nucleated  (Goodsirs),  44 

theory  of,  44 

Centrum  ovale,  164 — 165 
Cephalic  ganglia,  66 — 67,  85 
Cerebellum,  185,  203,  217,  225,  261 


Cerebellum  of  animals,  104,   112  (elephant), 
116,221,223—225 

arteries  of,  243 

birds,  95—96 

fishes,  36 

flying  fish,  36 

ganglia,  85 

laminated  ganglia,  220 

commissures,  211,  215,  221,  230 

man,  189—194,204 

Cerebral  or  brain  system,  57 

ganglia,  166 

vessels,  126—129,  142,  241,  244 

Cerebro-spinal  axis,  130,  181,  206,  257—268 

spinal  fluid,  139—141 

chemical  analysis  of,  141 

nerves,  46 — 57 

Cetacea,  brain  contains  oil,  38,  112—115,  122 

dura  mater,  133 

Chamois,  carotids,  128, 129 

Chaussier,  ganglionic  nerve,  58 

Cilia,  class  Tunicata,  63 

Cinereum  tuber,  89,  92,  103,  158,  159 

Cineritious  matter,  34,  37,  55,  56,  83,  96—98, 

164,  182,  204,  210—211,  215, 226,  231,  233, 
239 

of  cord,  174,  175—176,  181 

Clendinning,  weight  of  brain,  151 

Cloquet,  nervous  system  of  Ascaris,  52 

Cod,  optic  nerve,  232,  233 

Columns,  spinal,  70,  71,  131,  189—192,  197, 

200,  260 

Combe,  phrenology,  257,  258,  265 
Commissures,  cerebellum,  157 

inter-cerebral,  203 — 217 

great  transverse,  206 — 217 

longitudinal,  208—210,  260 

Chaussier,  211 

mollis,  2ia 

optic  nerve,  158 

organs  of  comparison,  56 

spinal  cord,  231,  171,  174 

the,  37,  52,  56,  71—73,  86—92,  94,  97, 

100,  101,  105,  110,  165,  166,  167,  169,  174, 

204,  206—217,  230,  259,  268 
Conductors,  insulated,  nerves,  42 
Conolly,  lunacy,  267 
Consciousness,  the  nervous  system  no  proof  of, 

50,  59,  264 

Continuity  of  nervous  filaments,  42 
Convulsive  diseases,  60 
Convoluted  surface  of  brain,  156,  159—163, 

165,  205 

Convolutions,  an  index  of  intelligence,  118 — 

126 
birds,  beasts,  &c.,  95,  96,  104,  105,  116, 

118,  160 

classified,  119—125,  159 

of  brain,  208—215 

longitudinal,  122,  159,  161,  163 

Cooper's,  Sir  A.,  experiments  on  rabbits,  44 

Mr.,  spinal  nerve,  176 

Cord,  spinal,  51 

Corpora  geniculata,  117,  166,  169,  234 

mammillaria,  158 

olivaria,  181—183,  188,  199 

ganglia  of  lingual  nerve,  111,  261 

striata,  87—92,  102,  105,  117,  166,  176, 

196,204,211,  262 

Corpus  callosum,  56—102,  117,  206—250 
Corpus  denticulatum,  215,  220 


INDEX. 


Corpus  fimbriatum,  214 

Corpuscles,  Pacinian,  40 

Cortical  substance,  a  distinct  ganglion,  55,  204 

Cranium,  a  series  of  vertebrae,  131 

Crocodile's  heart,  246 

Cruracerebelli,221— 223 

cerebri,  68—71,  102—106, 158,  176,  182, 

195,  200,  201,  213,  215 
Crustacea,  aganglionic,  71,  75 
Cruveilhier,  arachnoid,  137 

decussation  of  spinal  cord,  137 

medulla  spinalis,  175 

mode  of  dissecting  brain,  171 

•  nerves  of  dura  mater,  136 
Cryptoneura,  51 

Cuvier,  ganglionic  nerve,  51,  52,  59 
Cyclo-gangliata  of  Grant,  51,  58 
Cycloneurose  of  Grant,  51 

D. 

Decussation  of  pyramidal  bodies,  (Hippocrates, 
Aretaeus,  Dion,  Cassius,  &c.),  185—187,  210 

of  spinal  columns,  189,  202 

Deglutition,  60 

Dementia  condition  of  brain,  140,  141 
Desmoulins,  optic  thalami,  87 
Development,  brain  and  nerves,  244 — 256 

law  of,  53,  244—246 

Deville,  phrenology,  266 
Diemerbroeck,  gray  matter,  34 
Diploneurose  of  Grant,  51 
Divisions  of  animal  kingdom,  51,  52 
Dog,  cerebral  vessels,  129 

nerves,  230 

hemispheres,  264 

Dura  mater,  132—133,  138—143,  226 

cetacea,  133 

nerves  of,  135,  136 

E. 

Edentata,  104 

Egestion,  60 

Ehrenberg,  medullary  neurine,  39 

Electric  ray,  Cruveilhier,  90 

Elephant,  cerebral  vessels,  129 

Embryo,  heart,  246 

lungs,  246 

EncephaJon,  configuration  of,  156 
Eustachius,  trigeminal  nerve,  58 
Excito-motory  nerves,  37,  51,  57,  59,  60,  62, 

68,  175,  188,  230,  236,  239,  260,  262 
Eye,   theory   of   sight,   decussation   of   optic 

nerves,  231 
Eyelids,  action  of,  60 

F. 

Falx  major  and  minor,  133,  136 
Fat  of  brain,  M.  John's  analysis,  38 
Fibres  of  nerves  continuous,  41,  73,  145 
insulated,  42,  73 

gray,  46 

,  size  of,  46 

individually  endowed,  73 

of  re-inforcement,  70 — 73,  202 

•  of  spinal  cord,  70 

connected    with    cerebellum,    191, 

192,  194,  195 
connected  with  cerebrum,  198,200, 

205 
Fibrous  matter  of  brain,  33,  39,  42,  46,  49, 56, 

145,  207—215,  221—224 


Fibrous  neurine  of  cord,  174  —  178 
Figurate  surface  of  brain,  164  —  170,  208 
Fishes,  brain  and  cerebellum,  36,  82—92,  96, 

112,  159,  164,  169,  184,  206,  223,  226,  230, 

249-251,  262 

-  heart,  246 

-  lungs,  246 

-  sight  of,  232 

-  skull,  86 

•  thyroid  gland  or  branchiola,  243 
Fissura  Sylvii,  119—122,  159,  161,  210 
Fissure  of  spinal  cord,  172,  175 
Fletcher,  gray  matter,  36 
Fletcher's    Lectures,    history    of    ganglionic 

nerves,  58 
Flourens,  cerebellum,  193 

—  —  hemispheres  of  brain,  84 

-  manifestations  of  intellect,  263 
Fluid,  cerebro-spinal,  139  —  141 
--  •  chemical  analysis  of,  141 
Fornix,  56,  117,  166,  208,  209,  211 
Foville,  analysis  of  brain,  38 

-  auditory  nerve,  238 

-  cerebellum,  193 

-  convolutions  of  brain,  159 

—  —  corpus  callosum,  207 

-  decussation  of  nerve,  202 

-  pneumogastric,  239 

i  restiform  bodies,  182 

-  spinal  cord,  178,  179 
Frog,  heart,  47 

-  spinal  cord  and  sympathetic,  47,  178 

G. 

rain,  57,  58,  126,  166,  180 


Galen,  physiology  of  brai 
Gall,  cerebellum,  261 


-  gray  matter,  35,  120,  174 

-  olivary  bodies,  183 

-  phrenology,  265 

-  spinal  canal,  172 

-  weight  of  brain,  152 
Ganglia,  51,  54,  59,  65,  166,  206,  259 

-  auditory  and  pneumogastric,  66,  89,  93, 
94,  103,  109,  183—185,  239,  261 

-  at  base  of  optic  nerve,  85 

-  branchial,  66,  67,  90,  92 

-  cerebral  or  cephalic,  66—67,  165,  202,  203 

-  lingual,  110,  184 

-  medulla  oblongata,  182,  261 

-  nerves  enter  and  leave,  47 

-  of  sensation,  84,  85,  94 

-  of  7th  and  8th  pairs,  85 

-  of  spinal  cord,  roots  of  nerves,  172,  173, 
180,  193 

-  of  volition,  68 

-  pharyngeal,  67 

-  respiratory,  67,  69,  92,  94,  185 
—  —  semilunar,  55,  196 

-  their  nature,  54—57,  259 

-  hemispherical,  44,  55,  204—207,  262,  263 

-  tentacular,  269 

-  pedal,  65,  67,  69,  72,  75 

Ganglionic  system  of  the  sympathetic,  57  —  67, 

80 

Garner,  vision  of  oysters,  64 
Gasteropoda,  their  reproduction,  65 
Gelatinous  neurine,  46,  49 
Generation,  relation  of  brain  to,  98,  193,  261 
Giraffe,  rete  mirabile,  129 
Glands,  cells  and  tubes,  34  —  44 
two-fold  structure,  33—44 


INDEX. 


489 


Glandulae  Pacchionae,  132 
Grainger,  corpus  callosum,  207 

excito-motory  nerve,  260 

nervous  system,  51,  61 

spinal  cord,  175 

— —  third  pair  nerves,  235 

Grant,  divisions  of  nervous  system,  51,  58,  67 

Gray  fibres,  46 

matter  of  brain  or  neurine,  33,  42,  44,  55, 

60,  61,68,96,164,173—183,204,210,211, 

214,215,220,  221,239,240 
neurine,  source  of  power,  34,  36,  46,  56, 

179 

tubercle  in  brain,  89 

Goat,  vertebral  arteries  of,  127,  129 
Good,  Mason,  ganglionic  nerves,  58 
Goodsirs,  Messrs.,  nucleated  cells,  43 
Gottsche,  optic  ganglia,  88 
Gunz,  corpus  fimbriatum,  214 

H. 

Hall,  Dr.  M.,  excito-motory  nerve,  37,  51,  60, 
62,  67,  70,  74,  160,  165 

Haller,  cerebro-spinal  system,  50 

fluid,  139 

gray  matter,  34,  88,  96 

nerves  of  dura  mater,  136 

weight  of  brain,  151 

Hamilton,  Sir  W.,  weight  of  brain,  151 

Hannover,  corpuscles  of  brain,  47 

Hanwell  Asylum,  266 

Harwood,  rete  mirabile,  129 

Heads,  long,  indicate  intelligence,  119 

Heart,  progressive  development  of,  246 

Hedgehog,  cerebral  vessels,  129 

carotids,  125 

Helmhotz,  corpuscles  of  brain,  47 

Hemispheres,  not  the  seat  of  sensation,  263 

Hemispherical  ganglia,  46,  55,  84,  159—163, 
166,  204—205,  206,  207,  262,  263 

•         birds,  95 

fish,  84—86,  90—92 

sheep,  104, 118 

Henle,  gray  matter,  44,  46 

Hetero-gangliata,  51,  52,  57 

Hertwig  and  Flourens  on  intellectual  manifes- 
tations, 263 

Hippocampi,  117,  214,  215 

sense  of  smell,  214 

Hoare,  ganglionic  nerve,  58 

Holmes  Coote,  spinal  cord  of  fishes,  83 

Homo  gangliata,51,52,  67 

Human  brain,  anatomy  of,  130 — 243 

protective  apparatus  for,  130 

Human  brain,  weight,  145 — 155.  Tables  of, 
147—150 

Hunter,  John,  whale's  brain,  115 

Hydra  viridis,  59 

I. 

Idiot,  convolutions  of  brain,  160 
Imperceptible  sensation,  59 
Implacentalia,  97 
IncideAt  nerves,  59 
Incubation  of  egg,  53 
Infant's  brain,  39,  205,  226 
Inflammation,  chronic,  of  brain,  205 
Infundibulum,  158,  226 
Ingestion,  60 

Insanity,  change  of  cortical  substance,  165,204, 
205,  266,  267 


Insects'  brain,  size  of,  69 

Insectivora,  116,  119 

Intellect,  its  seat  in  brain,  46,  75 

convolutions,  118,  119 — 126,258 

long  heads, 119 

Intestinal  villi,  44 
Instinct,  nerves  of,  67,  68,  263 
John's  M.,  analysis  of  brain,  38 
Irritability  of  muscle,  37 
Jules  Cloquet,  Ascaris,  52 

K. 

Kangaroo,  98— 113,  122—125 

Knox,  arachnoid,  136 — 143 

Kolliker,  cerebro-spinal  system,  46,  47,  48 

L. 

Laennec,  nerves  of  Ascaris,  53 

Laminae,  cerebellum  of  birds,  96 

Lancisi,  ganglionic  nerve,  58 

Larynx,  pneumogastric,  239 

Lateral  sinuses,  135 

Lauth,  gray  matter,  34 

Law  of  development,  53,  244,  246 

Legallois,  cerebro-spinal  system,  60 

Leopard,  cerebral  vessels,  129 

Leuret,  brain  of  animals,  109, 117, 118,  119— 

126 

birds,  95,  96 

fishes,  85,  93,  94 

convolutions,  159 

Lieutaud,  nerves  of  dura  mater,  136 
Life,  animal  and  vegetable,  56,  57 

organic,  of  Bichat,  57,  59 

phenomena,  two  kinds,  56 

Ligamentum  denticulatum,  143 

Lingual  nerves,  ganglia,  111,  114,  184 

Lobstein,  nerves  of  dura  mater,  136 

Locomotion  of  Gasteropoda,  66,  67 

Locus  perforatus,  160 

Locus  niger,  caudate   vesicles,  43,   198,  202, 

213,  215,  262 

quadrilateralis,  159,  210 

Long  heads  indicate  intelligence,  119 
Longitudinal  commissure,  208 — 210,260,261, 

265,  266 

— —  sinuses,  135 
Lumbar  nerves,  260 
Lunacy,  267 

M. 

Macartney,  filiform  process,  143,  144 

Magendie,  cerebellum,  193 

cerebro-spinal  fluid,  139,  140 

— '• —  nerves  of  sensation,  260 
'  roots  of  spinal  nerves,  172 

Mammalia,   classified    according  to   convolu- 
tions, 118—124,  125 

number  of  cervical  vertebrae,  174 

Mamillary  tubercle,  117,  158 

Man's  brain,  comparative  anatomy  of,    118 — 
126 

Mayo,  cerebellum,  a  volatic  pile,  220 

decussation  of  optic  nerve,  231 — 232 

fibres,  corpus  callosum,  207,  208 

fifth  pair,  188 

gray  matter,  35,  60,  165 

lingual  nerve,  240 

nerves  of  sensation,  260 

Meckel,  auditory  nerve,  239 

ganglionic  nerve,  58,  59 


INDEX. 


Meckel,  gray  matter,  34 

spinal  columns,  191 

Medulla  oblongata,  dissection  of,  193 — 195 

ganglia,  66,  69,  80,  107 

man,  170,  175,  181—203,  219,  261 

respiration,  60—65,  159 

sheep,  107—112,  114 

spinalis,  171 

Medullary  matter,  34—39,  43,  46,  203 

neurine,  conductor  of  power,  34,  37,  46, 

56, 259 

neurine  of  cord,  174 

Membranous  matter,  basis  of  organs,  33 

Mental  exertion,  excretion  of  phosphorus,  44 

Mesentery  of  cat,  Pacinian  corpuscles,  40 

Monro,  ganglionic  nerve,  58 

Morgagni,  spinal  canal,  172 

Motor  and  sensory  columns,  166,    181 — 187, 

196,  199,  202 
tract,  187—198,  203,  216,  223,  229,  235, 

236,  237 

root  of  fifth,  236 

Movements  of  brain,  138 

Muller,  continuity  of  nervous  fibres,  145 

contraction  of  muscles,  259 

decussation  of  optic  nerve,  232,  234 

intellect,  263 

Muscle,  irritability,  36 
Muscular  contractions,  259 
Myelencephala,  51,52,  82 

N. 

Nematoneura,  51,  52 
Nerves,  base  of  brain,  159 

cerebral,  description  of,  229—240,  259 

commissures  of,  37,  52,  54,  259 

conductors,  56 

entering  and  leaving  ganglia,  47,  48 

excito-motory,  37,  52,  54,  57,  59,  172, 

173—185 

gelatinous,  34,  46 

lingual,  111,114 

medium    of   connection    with    external 

world,  51,  258 

not  similar  to  blood-vessels,  42 

of  antennae,  68 

of  dura  mater,  135 

of  instinct,  67,  74,  263 

of  involuntary  muscles,  48 

of  mandibles  and  maxillae,  68 

of  spinal  cord,  roots,  172,  174,  260 

origin  of,  porpoise,  114 

— -  peripheral  anastomosis,  41 

spinal  accessory,  239 

their  number,  229,  230 

1st,  olfactory,  229—230 

2d,  optic,  229— 231 

3d,  oculo-muscular,  230,  235,  237 

4th,  pathetic,  235 

5th,  trigeminal,  55,  58,  232,  236 

6th,  abducentes,  230,  237 

7th  &  8th,  229,  230,  237 

7th,  facial,  portio  dura,  237 

8th,  auditory,  portio  mollis,  238,  239 

9th,  glosso-pharyngeal,  229,  230,  239 

10th,  pneumogastric,    par   vagum,  229, 

230,  239 

llth,  lingual,  240 

Nervous  fibres,  continuous,  42,  56,   74,  145, 

259 
— — pressed,  the  consequences,  48 


Nervous  fibres,  protected,  why,  48 

sympathetic,  48 

ring,  oesophagus,  54,  60 

system,  absent  in  hydra  viridis,  59 

classifies  animals,  51 

its  magnitude   in  relation  to  animal 

endowments,  51 ,  77,  79,  81 ,  82—84,  92,  95, 

96,99,   100,   112,  118—126,165,171,258, 

263,  264,  265 

no  proof  of  consciousness,  51 

relation  to  alimentary  canal,  59 

simplest  form,  53--— 59 

Neurilemma,  47, 143,  175 

Neurine,  its  nature  and  mode  of  distribution, 

33,  34,  42,  43,  49—51,  55,  56,  76,  77,  95, 

103,  143,  145,  173,  182,  187,  206,  259 

subtle  in  insects,  31,  32 

medullary,  259 

not  visible  in  foetus,  247 

pulpy,  42,  56,  173,  195,  250 

nuclei,  43 — 45 

two  kinds,  34,  55,  56,  173,  259 

vesicular,  ganglia,  259 

Newport,  nervous  system,  51,  61,  67,  69,  257, 

260 
Niger  locus,  caudate  vesicles,  43,  198,  202, 

213,215,262 
Noble,  phrenology,  266 
Nucleated  cells,  43,  44,  46 
Nutrition  an  organic  function,  59,  74 

-  0< 
Occipital  sinuses,  135 

(Esophagus,  nervous  ring  of,  54,  66,  68,  74, 

75,77,78,82,83 
Oil,  brain  of  Cetacea,  38 
Old  age,  brain,  205 
Olfactory  ganglia,  85,  93,  94,  95,  96,  101,  104, 

115,  116,  179,214,  231,260 

whiting  and  carp,  86,  90 

Opossum,  117 

Optic  ganglia,  85,  86,  88,  93,  95,  97,  98,  99, 

100,  101,  115,  158,  169,  199,  203,  216,  231, 

260,  262, 263 

nerves,  whiting  and  carp,  86,  90 

thalami,  116,  l'l7,  202,  203 

Organic  life,  57,  58,  68,  69 

Orycteropus,  122 

Ostrich,  96 

Otter,  cerebral  vessels,  129 

Otto,  membranes,  brain,  53,  138 

Ovum,  development  of,  247 

Owen,  divisions  of  nervous  system,  51,  74,  79 

placentalia,  97 

convolutions,  119 

Ox,  cerebral  vessels,  129 
Oyster,  64  ;  vision,  64 

P. 

Pacchionus,  132 
Pachydermata,  109,  113 
Pacinian  corpuscles,  40,  41 
Paget,  cerebro-spinal  system,  46 
Pappenhein,  nerves  of  dura  mater,  136* 
Paralysis,  loss  of  exercise  of  will,  37,  48 
Peacock,  weight  of  brain,  151 
Pedal  ganglion,  65,  66,  67,  72,  75 
Pellatan,  decussation,  optic  nerve,  233 
Peripheral  nerves  anastomose,  41 
Permanent  skeleton,  130 
Petrosal  sinus,  135 


INDEX. 


491 


Pharynx,  60,  67 

Philip,  Wilson,  58 

Philosophy,  Newtonian,  245 

Phosphorus  in  brain,  38,  44,  45 

Phrenic   nerve,   diaphragm,   mammalia,    174, 

185,260 
Phrenology,    131,   215,  258,  259,   264—266, 

268 
Physiology,  245 

cerebral,  of  the  older  physicians,  259 

cerebro-spinal  system,  257 — 268 

Pia-mater,  137—143,  166,248 

filiform  process,  143,  144 

spinal  cord,  172,  175 

Pig,  carotids,  127 

Pineal  gland,  93,  94,  100,  102,101,  113,117, 

118,  169,  210  (Amphibia) 
Pituitary  gland  (skate)  92,  107,  226 
Placenta,  similarity  to  plexus  choroid,  138 
Placentalia,97,  101 
Plexus  choroid,  113,  137,  138,  166 
Polydermidae,  68,  71 
Pneumogastric,  60,  64,  93,  94,  103,  114 
Polypus,  59,  62 
Pons  Varolii,   100—108,   116,  153,  169,  183, 

195,  200,  201,  203,  211,  218,  220,  222,  261 

deficient  in  birds,  reptiles,  &c.,  97 

Porpoise,  carotids,  126 
Portal,  nerves,  dura  mater,  135 

spinal  canal,  172 

Portio  dura,  145 

Posterior  roots  spinal  cord,  55 

Prichard,  cerebellum,  193 

Prochaska,  excito-motory,  239,  260 

Propagation  by  germs,  63 

Prout,  phosphate  urine,  44 — 46 

Purkinge,  axis  cylinder,  40 

Pulpy  neurine,43,  173,  195 

Pyramidal   bodies,  and  decussation  of  fibres, 

185—187, 199,  201,  210,  261 

R. 

Rabbit,  embryo  of,  248 

Radiata  of  Cuvier,  51,  63 

Rapp   of  Tubingen,   vertebral   arteries,   127, 

129 
Reflex  functions  of  nerve,    59,  70,  73,   175, 

263,  264 
Reid,  medulla  oblongata,  134,  198,  199 

weight  of  brain,  146—151 

Reil,  cerebellum,  218,  221 

of  birds,  223 

gray  matter,  35,  96 

mode  of  preparing  cerebellum,  217 

Remak  fibres,  47 

Reptiles,  82,  93,  95,  112,  250,  255,  262 

Respiration,  60 — 67,  94,  184,  185 

Restiform  ganglia  (Ruysch  and  Rolando),  181 — 

184,  191,  200,  221,  261 
Rete  mirabile  (Galen),  126,  127,  241 
Retzius,  foetal  brain,  254 
Richerand,  ganglionic  nerve,  59 
Rodentia,  98—129 
Rolando,  corpus  callosum,  208 

foetal  brain,  248 

optic  thalami,  235 

nerves,  231 

septum  lucidum,  213 

spinal  cord,  175,  182,  192 

Roots,  posterior  spinal  cord,  55 
Rosenthal,  axis  cylinder,  40 


Ryan's  Journal,  gray  matter  source  of  power, 

36 

Rudolphi,  divisions  of  nervous  system,  51 
Ruminantia,  104—129 
Ruysch,  gray  matter,  34,  35 

S. 

Salivary  glands,  68 
Scarpa,  ganglionic  nerve,  58,  88 
Schleidan,  villi,  44 

Schoeps,  experiments  on  cerebrum,  264 
Schwann,  white  substance  of  brain,  40,  44,  49 
Scolopendra,  71 
Section,  vertical,  of  brain,  157 
Secretion,  an  organic  function,  59 
Senile  atrophy  of  brain,  39 
Sensation,  imperceptible,  59 
,  nerves  of,  37,  172—188,  230,  236,  239, 

260, 

Sensory  tract,  187—189,  200—203 
Septum  lucidum,  166,  214 
Serosity  of  brain,  38 
Serres,  brain  of  birds,  96 

fishes,  85,  89,  92 

spinal  cord  of  foetus,  249 

Sheep,  rete  mirabile,  127 — 129 
Sight  and  smell  of  Gasteropoda,  66 
Simon,  theory  of  thyroid,  243 
Sims,  weight  of  brain,  145,  151 
Sinuses,  cerebral,  134 — 142 
Skate,  optic  nerves  of,  232 
Skeleton,  earliest  development,  79 

shelly,  dermal,  130 

to  protect  nerves,  79,  82 

Skull  alters  with  age,  131 

mode  of  opening,  131,  132 

of  fishes,  85 

to  protect  brain,  82,  130,  131 

Soemmerring,  number  of  nerves,  229 

weight  of  brain,  151 

Speech,  organs  of,  261 
Sphincters,  60—64 
Spina  bifida,  140 

cerebrata  of  Grant,  51,  67 

Spinal  arteries,  142,  242 

Spinal  cord,  37,  41,  46,  51,  53,  55,  60,  61,  67— 

69,  82,  103,  156,  169,  171,  182,  248,  261 

commissures,  260 

connection  with  cerebrum,  181 

dissection  of,  171 — 181,  185,  187' 

distinct  nervous  centre,  177,  180 

dura  mater,  143 

fishes,  83 

fissures  of,  177 

fetus,  83,  249 

ganglia,  172,  173 

gray  matter,  173 — 180,  185 

how  to  remove  it,  142, 143 

incubated  egg,  53 

roots  of  nerve,  55,  172 — 177 

structure  in  insects,  69 

transverse  section  of,  172 — 174 

various  nerves  of,  175—179,    187,   199, 

260,  262 

Spinal  system,  57—58,  67,  260 
Spirostrepti,  Spiroboli,  71 
Spurzheim,  decussation  of  pyramidal  bodies, 

186 

gray  matter,  35,  120 

number  of  nerves,  230 

optic  thalami,  235 


492 


INDEX. 


Spurzheim,  phrenology,  266 
— —  spinal  canal,  172 

weight  of  brain,  152 

Stadelman,  axis  cylinder,  40 
Stag,  carotids,  127—128 
Stein,  optic  thalami,  235 
Stilling,  lingual  nerve,  240 

nervous  fibres,  41,  42 

pneumogastric,  239 

spinal  canal,  174 

Stomach,  simplest  animal  construction,  51 

Substantia  perforata,  159 

Swammerdam,  arachnoid,  132 

Swine,  cerebral  vessels,  129 

Sylvius,  gray  matter,  34 

Sympathetic,  the,  34,  46—48,  57—58,  68,  70 

237 
pituitary  gland,  its  ganglion,  226 

T. 

Tactual  ganglia,  262 

Taenia  semicircularis,  166,  214 

Temporary  skeleton,  130 

Tentacula,  64—66 

Tentorium,  133 

Thalami   nervum   opticorum,   166,  202,   210, 

215,  226,  235,  253,  262 
Theca  vertebralis,  165 
Thyroid,  theory  of,  243 
Tiedemann,  corpus  callosum,  206,  207,  211 

foetal  brain,  87,  248—252 

gray  matter,  35,  36 

nerves,  231 

starfish,  53 

weight  of  brain,  151 

Tiger,  carotids,  126 

Todd  and  Bowman,  43,  262 

axis  cylinder,  40,  41,  262 

cerebro-spinal  fluid,  140 

filiform  process,  143,  144 

glandulae  Pacchioni,  132 

olivary  bodies,  183 

pituitary  gland,  226 

spinal  canal,  173 

Torcular  Herophili,  135 

Tract,  sensory  and   motory,    187—198,   221, 

223,229,236,  237,  261,262 
Tractus  opticus,  158,  195,  233,  234 
Transverse  commissure,  206,  260,  261 
Treviranus,  gray  matter,  34,  88 
Trifacial  ganglia,  85 
Tuber  cinereum,  89,  92,  103,  158,  159 
Tubercula  quadrigemina,  85,  87,88,  102,  106, 

262,  263 

Tubes  of  glands,  34 

Tubular  neurine,  34,  37,  39,  41,43,46,  48,  55 
Tunica  arachnoidea,  133,  136 — 143 
Turtle,  respiration,  94 
Twain  band  or  fornix,  212 

V. 

Valentin,  gray  matter,  41,  42,  47 
Valsalva,  nerves  of  dura  mater,  136 
Valve  of  Vieussens,  169,  215 
Vauquelin,  analysis  of  brain,  38 
Veins,  cerebral,  133,  134, 166 


Veins  of  spinal  cord,  142 
Velum  interpositum,  169 
Vena  Galeni,  166 
Ventricle,  fifth,  166 

fourth  (whiting),  86,  161,  201 

of  brain,  86,  105, 117, 136,  137,  140,  160, 

164, 165,  166—168,  201,  203,  209,  210,  253 
Vertebrata,  51,  61,  68,  141,  180,  226 
Vertebral  arteries  126 

column,  130 

Vertical  section  of  brain,  157 

Vesicular  neurine,  source  of  power,  33 — 37, 

42—44,  50,  205,  259,  261 
Vessels  of  brain,  126—128,  166,  241—243 
Vermiform  process,  218,  219,  224,  225 
Vicq  d'Azyr,  cerebellum,  220 

corpus  callosum,  206 

optic  ganglia,  88 

Vieussens,  ganglionic  nerve,  58 

gray  matter,  34,  212 

nerves  of  dura  rriater,  136 

Villi,  intestinal,  44 

Vimont,  cerebellum,  264 

Visceral  nerves  (lulus),  68 

Vomiting,  60 

Volckmann,  cerebro-spinal  system,  46,  47 

Volition,  lost  by  paralysis,  37,  172 

nerves  of,  37,  67—69, 172,  178, 179,  188, 

239,  259,  264 

W. 

Wagner,  Rudolph,  weight  of  brain,  145 
Walker,  posterior  columns,  193 
Wallach,  spinal  canal,  173 
Wasting  of  brain,  39,  45,  141,  145,  267 
Weazel,  cerebral  vessels  of,  129 
Weight  of  brain,  145—155 

tables,  147—150 

Wengel,  glandulae  Pacchioni,  132 
Wenzel,  corpus  callosum,  206 

foetal  brain,  251 

gray  matter,  35 

hippocampus,  214 

—  optic  nerve,  239 

—  weight  of  brain,  152 
Whale,  brain,  its  weight,  145 
Wheatstone,  decussation  of  nerves,  232 
White  substance  of  brain,  46,  48 
Whytt,  excito-motory,  260 

—  reflex  function,  74 

Will,  on  corpuscles  of  brain,  47 
Will  or  volition,  excito-motory,  51,  61 
Willis,  ganglionic  nerve,  58 

—  gray  matter,  35 

-  nerves,  230 

weight  of  brain,  145 

-  the  circle  of,  127,  128,  129,  242 
Winslow,  ganglionic  nerves,  58 

—  nerves  of  dura  mater,  136 
Wollaston,  semi-decussation  of  optic  nerves, 

231,233 
World,  external,  medium  of  connection  with, 

the  nerves,  50 

Wrisberg,  nerves  of  dura  mater,  136 
Wutzer,  ganglionic  nerves,  59 


INDEX. 


493 


PATHOLOGY  OF  THE  BRAIN. 


A. 

Abercrombie,  anarnic  coma,  282 

apoplexy,  364 — 366 

simple,  390 

of  cerebellum,  385 

bleeding  in  apoplexy,  395 

cerebral  fullness,  270 

coma,  344 

inflammation  membranes,  313 

organic  disease  of  the  brain,  433 

ramollissement,  293,  294 

i  treatment  of  inflammation,  352 — 354 

tumors  of  brain,  464,  469,  471 

Abernethy,  trephining,  417 
Abscess  of  cerebellum,  385 
Aconite  in  epilepsy,  447 
Actual  cautery,  353 
Adams,  simple  apoplexy,  390 
Alison,  determinations  of  blood,  431 

inflammation  of  brain,  362 

simple  apoplexy,  390 

Andral,  apoplexy,  334 

of  cerebellum,  384 

convulsions,  338 

corpus  striatum,  lesion  of,  375 

effusion,  349 

induration,  351 

meningitis,  313,  315,  316,  340,  341 

ramollissement,  291,  293 

Anaemic  affections,  273—275,  362,  366 

coma,  281,  288 

Apoplexy,  363 — 374 

simple,  390—394 

base  of  brain,  366—370 

cerebellum,  382—384 

meningeal,  365,  378-9,  470 

— —  premonitory  symptoms,  how  treated,  393 

serous,  366,  387,  390,  418 

treatment,  393—405 

Arachnoid,  inflammation  of,  305, 313 — 315, 322 
Armstrong,  delirium  tremens,  276 
Arnott,  determinations  of  blood,  431 
Asthma  and  hypertrophy  of  brain,  481 — 483 
Atrophy  of  brain,  302,  481 

B. 

Bayle,  mental  alienations,  314 
Bell,  B.,  trephining,  417 
Bennett,  hydrocephalus,  285 

Hughes,  ramollissement,  295 

Blake,  delirium  tremens,  275,  276,  280 
Bleeding,  in  epilepsy,  446,  447 

apoplexy,  extent  of,I392 — 396,  398 

Blood  corpuscles  in  inflammation,  294 — 296 

determinations  of,  431 — 435,  443 

Brain,  debility  of,  432 

elasticity  of,  478 

organic  disease  of,  433,  463 — 478 

weight  of  in  disease,  482—484 


Bright,  bleeding  in  apoplexy,  396 

cerebral   irritation,  304,  306,  307,  343, 

432,  433 

congestive  epilepsy,  446 

danger  of  calomel  in  apoplexy,  402 

— —  nux  vomica  in  paralysis,  402 

pituitary  gland,  438 

sanguineous  apoplexy,  385 

tumors  of  brain,  496 

Burrows,  bleeding  in  apoplexy,  398 

cerebral  fullness,  270—272,  432 

meningeal  apoplexy,  378 

simple  apoplexy,  389 

strychnia  in  paralysis,  408 

C. 

Calomel,  danger  of,  in  apoplexy,  402 
Carotids,  effects  of  tying,  274 

in  epilepsy,  274,  437 

•  throbbings  of,  431 
Carswell,  meningeal  apoplexy,  378 
Case  of  abscess  cerebellum,  384 

amaurosis,  359 

•         anaemic  apoplexy,  366 

apoplexy,  365,  370,  371,  375,  376,  377, 

379,  380,  382,  383,  384,  387,  389,  391,  395, 

396 

fright,  334 

atrophy  of  brain,  303 

cerebral  anaemia,  288,  289 

concussion,  318,  319,  320 

convulsions,  343,  371,  405,  422 

delirium  tremens,  277,  281 

epilepsy,  428,  430,  440,  443,  444,  447, 

448,  457,  459,  460 

from  cold,  438 

from  syphilis,  439 

hysterical,  441 

tying  carotid  for,  437 

use  of  digitalis,  436,  437,  450,  454 

use  of  turpentine,  460,  462 

erysipelas,  285,  288 

fracture  of  skull,  and  convulsions,  411 

hydrocephalus,  296 

•"        of  hypertrophy  and  induration  of  brain, 

477,  479—481 

inflammation  of  brain,  bleeding,  352 

— cortical  substance,  308,  312 

dura  mater,  322,  325 

from  fright,  328,  329 

use  of  purgatives,  355 

— —  inflammation  of  the  brain  with  effusion, 

348 
— —  injury  of  the  head,  411 

mania,  306,  326,  327,  333 

— —  meningitis,  347 

chronic,  359,  361 

mental  irritability,  335,  337,  339,  340 

ossification  of  dura  mater,  323,  325 


494 


INDEX. 


Case  ofotitis,  322 

paralysis,  374,  403 

softening  of  brain,  290,  298 

syphilitic    inflammation    of   brain,    326, 

327,  439 
•  thahim.  nerv.  optic.,  lesion  of,  377 

trephining,  411 

— —  tubercular  deposit  of  brain,  469 

tumor  of  brain,  468,  473 

Cautery,  actual,  352 

Circulation  through  the  encephalon,  variable, 

270—273 

Centric  and  centripetal  convulsions,  427 
Cerebellum,  abscess  of,  385 

apoplexy  of,  382— 384 

inflammation  of,  303 

Cerebral  anaemia,  289 

Cerebro-spinal  softening,  two  kinds,  297 

Chevers,  Norman,  effects  of  tying  the  carotid, 

273,  274 

Chlorosis,  anaemia  of  brain,  276,  278 
Choroid  plexus,  hyperremia  of,  in  epilepsy,  366 

seat  of  organic  disease,  470 

Cineritious  matter,  source  of  power,  307 

substance  of,  diseased,  306 

Cold,  cause  of  epilepsy,  438 

ablutions,  effect  of,  in  apoplexy,  355,  392 

Colles,  use  of  mercury,  360 
Coma,  343,  390 

anaemic,  from  exhaustion,  281 

Concussion,  317—320 

Congestive  apoplexy,  390 

Convulsions,  338,  343,  344,  405, 423,  427,  437, 

479—482 

Convulsions  after  injury  of  the  head,  411 
Cooper,  Sir  A.,  epilepsy,  426 
— —  experiments   on   cerebral  and   vertebral 

arteries  of  dogs,  273,  274 
Copeman,  bleeding  in  apoplexy,  401 
Copland,  apoplexy,  432 

bleeding  in,  3,96 

.  cause  of  epilepsy,  434 

delirium  tremens,  275 

induration  of  brain,  350 

tumors  of  brain,  468 

Corpus  striatum,  lesion  of,  374,  376 
Corrigan,  digitalis  in  epilepsy,  449,  450 
Creosote  in  epilepsy,  444 
Croton  oil  in  apoplexy,  402 
Crowing  inspiration,  452 
Cruveilhier,  atrophy  of  brain,  302 

ramollissement,  393 

tumors  of  dura  mater,  466,  468 

D. 

Dance,  hypertropy  of  brain,  479 
Delirium,  315,  316 

tremens,  275 — 281 

Dementia,  350 

Dentition,  351,  427 

Depletion,  delirium  tremenf,  279 

Development  of  brain  in  fetus,  arrest  of,  302 

Deville,  hypertrophy  of  brain,  477 

Diet,  delirium  tremens,  280 

Digitalis  in  epilepsy,  435,  436,  437,  447,  449, 

450,  453 

Diseases  of  brain,  divisions  of,  269,  270 
Douglas,  paralysis,  385 
Dupuytren,  delirium  tremens,  280 

wounds  of  the  head,  415 

Dura  mater,  inflammation  of,  321 


Dura  mater,  lacerations  of,  413,  415 

ossification  of,  323 

pulsation  of,  420 

pus  beneath,  421 

tumors  of,  464,  465,  466 

E. 

Ear-ache,  322,  323 
Effusion,  349 
Epilepsy,  422—463 

cause  of,  435,  438,  443 

congestive,  433,  446 

essential,  sympathetic  and  symptomatic, 

442 

forewarnings,  415,  437,  438,  448 

hysterical,  442 

intellect,  state  of,  425,  458 

prognosis,  440 — 446 

pulse,  444 

theory  of,  430 

treatment,  446 

tying  carotids  for,  274,  437 

Epileptic  attacks,  335,  480 

coma,  424 

similitudes,  364,  387 

Epidemic  meningitis,  351 
Eruptions  of  scalp,  dentition,  351 
Esquirol,  epileptic  plethora,  433 

kinds  of  epilepsy,  442 

prognosis  in  epilepsy,  443 

F. 

Fatuity,  279,  302 

Fardell,  ramollissement,  349 

Fear,  cause  of  meningitis,  328 

Ferriar  on  digitalis,  449 

Foville,  epileptic  plethora,  433,  445 

G. 

Georget,  epilepsy,  426 

Gluge,  ramollissement,  295 

Gooch,  anaemic  coma,  283 

Green,  tumors  of  brain,  468,  469  *  -*-«r~ 

Guthrie,  injuries  of  head,  415 

pulsation  of  dura  mater,  421 

trephining,  419 

H. 

Hamilton,  digitalis  in  epilepsy,  449 

Hall,  Dr.  M.,  coma  from  exhaustion,  281 — 283 

convulsions,  427,  428 

Haematoma  of  brain,  470,  471 

Hssmorrhoidal  evacuations,  353 

Hardening  of  brain,  305 

Head,  determination  of  blood    to,  431,  435, 

437,  438, 443 
Headache,  meningitis,  340—343 

1 organic  disease  of  brain,  433 

Heart  disease,  a  cause  of  apoplexy,  367,  368, 398 

epilepsy,  447 

Hemispheres  inflamed,  303 — 316,  322,  228 — 

349 

symptoms,  307,  406 

Henle,  ramollissement,  294 

Hennen,  trephining,  418 

Hewett,  meningeal  apoplexy,  378 

History  of  the  pathology  of  convulsions,  447 

Holland,  epileptic  plethora,  434 

indiscriminate  blood-letting,  399 — 401 

inflammation  of  brain,  353 

use  of  mercury,  363 


INDEX. 


495 


Hooper,  hsematoma,  470 
Hunter,  John,  trephining,  417 
Hydatids  of  choroid  plexus,  433,  470 
Hydrocephalus,  281,  285,  302,  478,  483,  484 
Hydrocyanic  acid  in  epilepsy,  447 
Hyperaemia  of  brain,  symptoms,  279,  285,  304 

—328,  351,  362 

Hypertrophy  of  brain,  477 — 484 
Hysterical  epilepsy,  442 

T. 

Ice,  application  of,  355 

Idiotcy,  from  hypertrophy  of  brain,  477,  482 
Indigestion,  cerebral  disturbance,  369 
Induration  of  brain,  350—351,  477,  481,  482 
Inebriation,  308 
Infants,  coma  of,  282 
Inflammation,  blood  corpuscles,  295,  297 

of  brain,  e'xternal,  303 

internal,  304,  328 

Intellect,  deranged,  308,  315,  318,  339,  344, 

425,  479,  481,  482 
Intellectual  precocity,  477 
Insanity,  302,  305,  315—327,  333,  350,  351, 

354—359,  369,  431,  443 
Joy,  cause  of  meningitis,  328 

K. 
Kellie,  cerebral  fullness,  270 

L. 
Laennec,  induration  and  hypertrophy  of  brain, 

478,  480 
Lallemande,  convulsionsj  407 

ramollissement,  291 

Lawrence,  trephining,  408 
Light,  effect  of,  delirium  tremens.  276 
Liver,  enlargement  of  thymus  gland,  482 
Louis,  tumors  of  dura  mater,  464,  469 
Lugol,  tumors  of  the  brain,  469 
Lunatics,  351,  354 

M. 

Mania,  compared  with  delirium  tremens,  276 
Martinet,  meningitis,  315 
Mayo,  apoplexy,  406 
Mauthner,  hypertrophy  of  brain,  482 

weight  of  brain,  481 

Medulla,  conductor  of  power,  308 

inflamed,  304,  306—343 

oblongata,  apoplexy  of,  371 

Meningeal  apoplexy,  378—382 
Meningitis,  304,  313—318,  337—339,  361 
Mental  imbecility,  305,  306,  357 

irritability,  335,  339,  369,  405 

Mercury,  use  of,  358 — 362 
Monro,  cerebral  fullness,  270 
Morgagni,  induration  of  brain,  478 

lesion  of  corpus  striata,  375 

paralysis,  408 

scirrhus  of  cerebellum,  385 

serous  apoplexy,  478 

softening  of  brain,  291 

Munk,  digitalis  in  epilepsy,  449 

N. 
Nux  vomica,  paralysis,  402 

0. 

(Enanthe  crocata,  produces  epileptic  convul- 
sions, 437 


Ollivier,  apoplexy,  405 

Opium,  use  of,  delirium  tremens,  279 — 280 

inflammation  of  brain,  320,  362 

Ossification  of  dura  mater,  323,  325 
Otitis,  322 

P. 

Paralysis,  338,  385,  402,  407,  408,  409,  421 

Parent  Duchatelet,  meningitis,  315 

Payen,  induration  of  brain,  351 

Peacock,  ramollissement,  298 

Phthisis,  atrophy  of  brain,  482 

Pia  mater,  inflamed,  313,  322 

Pinel,  induration  of  brain,  351 

Pituitary  and  pineal  glands,  (Copland,)  432 

Pituitary  gland,  epilepsy  (Wenzels),  432,  438 

Pneumonia,  increased  weight  of  brain,  482 

Pons  Varolii,  apoplexy  of,  371 

Portal,  lesions  of  cerebellum,  385 

Prichard,  inflammation  of  brain,  353 

determinations  of  blood,  443 

Pruss,  meningeal  apoplexy,  380 
Pulsations  of  brain,  420 
Pulse,  delirium  tremens,  280 

epilepsy,  444 

Pupil,  contracted  or  dilated,  344,  414 

R. 

Rachitis  and  hypertrophy  of  brain,  482 — 483 
Radial  nerve,  removal  for  epilepsy,  426 
Ramollissement,  281,  290—302,  305,  349,  384 

its  nature,  292,  293,  294 

Respiration  arrested  by  apoplexy,  390 
Rheumato-syphilitic  inflammation  of  brain,  325 
Rogers,  account  of  apoplexy  at  Madras,  392 
Rollett,  actual  cautery,  meningitis,  352 
Rostan,  ramollissement,  291,  294 


Saunders,  delirium  tremens,  275 

Sauvages,  epilepsy,  426 

Scarlatina,  increased  weight  of  brain,  482 

inflammation  of  brain,  327 

Senile  atrophy  of  brain,  302 
Sensation,  deranged,  307 
Serous  apoplexy,  387—390 

effusion,  389,  396 

—— delirium  tremens,  276,  305 

Sewell,  Brodie,  serous  apoplexy,  389 

Shower-bath  in  epilepsy,  461 

Sieve-like  softening  of  brain,  349 

Signs  of  injury  of  brain,  414 — 417 

Silver,  oxide  of,  in  epilepsy,  447,  449,  458, 

460 
Sims,  hypertrophy  of  brain,  478,  481 

ramollissement,  298 

Skull,  thick,  insanity,  324 

Smith,  Mr.  E.,  cause  of  epilepsy,  324 

Spinal  cord,  softening,  298 

Stimulants,  use  in  delirium  tremens,  280,  281 

Strychnia  in  paralysis,  403 

Sutton,  delirium  tremens,  275 

Syphilitic   inflammation  of  dura   mater,  323, 

439 

T. 

Thalamus  nervi  optici,  lesion  of,  377 
Thymus  gland,  enlarged,  482 
Treatment,  apoplexy,  393—405 

epilepsy,  446 

inflammation  of  brain,  352 — 353,  363 


496 


INDEX. 


Treatment,   premonitory  symptoms   of    apo- 
plexy, 394 

Trephining,  414—415 
Tubercular  deposits  of  brain,  469,  482 
Tubular  matter,  inflamed,  303 
Tumors  of  brain,  463 

diagnosis,  466 

symptoms,  470 — 473 

Turpentine  in  epilepsy,  447,  461 
Tyrrell,  therapeutics,  356 — 360 

V. 

Valentin,  ramollissement,  295 
Velpeau,  tumors  of  dura  mater,  466 
Ventricle,  left,  of  heart,  and  enlarged  thymus, 

482 


Vogel,  ramollissement,  295 
Volition,  deranged,  307 
Vomiting,  inflamed  medulla,  343 

W. 

Wagner,  ramollissement,  295 

Walshe,  tumors  of  dura  mater,  466,  467,  471 

Watson,  bleeding  in  apoplexy,  395 

cerebral  fullness,  272 

delirium  tremens,  277 

epilepsy,  427,  433,  461 

inflammation  of  dura  mater,  321,  322 

treatment  of  apoplexy,  394 

Wenzels,  pituitary  gland  in  epilepsy,  432,  438 
tumors  of  dura  mater,  465 


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Physiology,  can  obtain  it,  in  a  handsome  octavo  volume,  of  552  pages,  with  over  150  illustration?. 
by  mail,  free  of  postage,  on  a  remittance  of  $2  50  to  the  publishers. 

It  will  thus  be  seen  that  for  the  small  sum  of  FIVE  DOLLARS,  paid  in  advance,  the  subscriber 
wiil  obtain  a  Quarterly  and  a  Monthly  periodical, 

EMBRACING  ABOUT  FIFTEEN  HUNDRED  LARGE  OCTAVO  PAGES 

mailed  to  any  part  of  the  United  States,  free  of  postage. 

These  very  favorable  terms  are  now  presented  by  the  publishers  with  the  view  of  removing  all 
difficulties  and  objections  to  a  full  and  extended  circulation  of  the  Medical  Journal  to  the  office  of 
every  member  of  the  profession  throughout  the  United  Slates.  The  rapid  extension  of  mail  facili- 
ties, will  now  place  the  numbers  before  subscribers  with  a  certainty  and  dispatch  not  heretofore 
attainable;  while  by  the  system  now  proposed,  every  subscriber  throughout  the  Union  is  placed 
upon  an  equal  footing,  at  the  very  reasonable  price  of  Five  Dollars  for  two  periodicals,  without 
further  expense. 

Those  subscribers  who  do  not  pay  in  advance  will  bear  in  mind  that  their  subscription  of  b  ive 
Dollars  will  entitle  them  to  the  Journal  only,  without  the  News,  and  that  they  will  be  at  the  expense 
of  their  own  postage  on  the  receipt  of  each  number.  The  advantage  of  a  remittance  when  order- 
ing the  Journal  will  thus  be  apparent. 

As  the  Medical  News  and  Library  is  in  no  case  sent  without  advance  payment,  its  subscriber? 
will  always  receive  it  free  of  postage. 

It  should  also  be  borne  in  mind  that  the  publishers  will  now  take  the  r.isk  of  remittances  by  mail, 
only  requiring,  in  cases  of  loss,  a  certificate  from  the  subscriber's  Postmaster,  that  the  money  wa* 
duly  mailed  and  forwarded. 

feT  Funds  at  par  at  the  subscriber's  place  of  residence  received  in  payment  of  subscriptions. 

Address,  BLANCHARD  &  LEA,  PHILADELPHIA. 


AND    SCIENTIFIC    PUBLICATIONS. 


ANALYTICAL    COMPENDIUM 


OF  MEDICAL  SCIENCE,  containing  Anatomy,  Physiology,  Surgery,  Midwifery, 
Chemistry,  Materia  Medica,  Therapeutics,  and  Practice  of  Medicine.  By  JOHN  NEILL,  M.  D., 
and  F.  G.  SMITH,  M.  D.  Second  and  enlarged  edition,  one  thick  volume  royal  12mo.  of  over 
1000  pages,  with  350  illustrations.  J3F3  See  NEILL. 


ABEL  (F.    A.),    F.  C.  S. 
Professor  of  Chemistry  in  the  Royal  Military  Academy,  Woolwich. 

AND 

C.    L.    BLOXAM, 

Formerly  First  Assistant  at  the  Royal  College  of  Chemistry. 

HANDBOOK  OF  CHEMISTRY,  Theoretical,  Practical,  and  Technical,  with  a 

Recommendatory  Preface  by  Dr.  HOFMANN.     In  one  large  octavo  volume  of  .602  pages,  with 

illustrations.     (Now  Ready.) 

There  was  still  wanting  some  book  which  should  j  who  resolves  to  pursue  for  himself  a  steady  search 
aid  the  young  analytical  chemist  through  all  the  \  into  the  chemical  mysteries  of  creation.  For  such 
phases  of  the  science.  The  "  Handbook"  of  Messrs,  a  student  tfce  'Handbook'  will  prove  an  excellent 
Abel  and  Bloxam  appears  to  supply  that  want.  As  guide,  since  he  will  find  in  it,  not  merely  the  most 
Dr.  Hofmann  says  in  his  brief  Preface,  "  The  pre-  !  approved  modes  of  analytical  investigation,  |but 
sent  volume  is  a  synopsis  of  their  (the  authors')  ex-  ]  descriptions  of  the  apparatus  necessary,  with  such 
perience  in  laboratory  teaching  ;  it  gives  the  neces-  |  manipulatory  details  as  rendered  Faraday's  '  Che- 
sary  instruction  in  chemical  manipulation,  a  concise  mica!  Manipulations'  so  valuable  at  the  time  of  its 
account  of  general  chemistry  as  far  as  it  is  involved  publication.  Beyond  this,  the  importance  of  the 
in  the  operations  of  the  laboratory,  and  lastly,  quali-  i  work  is  increased  by  the  introduction  of  much  of  the 
tative  and  quantitative  analysis.  It  must  be  under-  ;  technical  chemistry  of  the  manufactory." — Athe- 
stood  that  this  is  a  work  fitted  for  the  earnest  student,  naum. 


ASHWELL   (SAMUEL),  M.  D. 
A  PRACTICAL  TREATISE  ON  THE  DISEASES  PECULIAR  TO  WOMEN. 

Illustrated  by  Cases  derived  from  Hospital  and  Private  Practice.    With  Additions  by  PAUL  BECK 
GOOOARD,  M.  D.     Second  American  edition.     In  one  octavo  volume,  of  520  pages. 


ARNOTT   (NEILL),  M.  D. 
ELEMENTS    OF    PHYSICS;    or  Natural  Philosophy,  General  and  Medical. 

Written  for  universal  use,  in  plain  or  non-technical  language.    A  new  edition,  by  ISAAC  HAYS, 
M.  D.    Complete  in  one  octavo  volume,  of  484  pages,  with  about  two  hundred  illustrations. 

BENNETT   (J.    HUGHES),    M.  D.,    F.  R.  S.  E., 

Professor  of  Clinical  Medicine  in  the  University  of  Edinburgh,  &c. 

THE  PATHOLOGY  AND  TREATMENT  OF  PULMONARY  TUBERCU- 

LOSES,  and  on  the  Local  Medication  of  Pharyngeal  and  Laryngeal  Diseases  frequently  mistaken 
for  or  associated  with,  Phthisis.     In  one  handsome  octavo  volume,  with  beautiful  wood-cuts. 
Now  publishing  in  the  "  Medical  News  and  Library"  for  1854,  and  furnished  gratis  to  advance- 
paying  subscribers  to  the  American  Journal  of  the  Medical  Sciences. 


How  it  may  be  most  effectually  carried  into  prac- 
tice, our  readers  will  learn  from  Dr.  Bennett's  pages, 
especially  from  the  histories  of  the  valuable  and  in- 
teresting cases  which  he  records.  Indeed,  if  the  au- 
thor had  only  reported  these  cases  he  would  have 
benefited  his  profession,  and  deserved  our  thanks.  As 
it  is,  however,  his  whole  volume  is  so  replete  with 
valuable  matter,  that  we  feel  bound  to  recommend 
our  readers,  one  and  all,  to  peruse  it.— Loud.  Lancet. 


The  elegant  little  treatise  before  us  shows  how 
faithfully  and  intelligently  these  investigations  have 
been  pursued,  and  how  successfully  the  author's 
studies  have  resulted  in  clearing  up  some  of  the  most 
doubtful  points  and  conflicting  doctrines  hitherto 
entertained  in  reference  to  the  history  and  treatment 
of  pulmonary  tuberculosis.— IV.  Y.  Journal  of  Medi- 
cal and  Collateral  Science,  March,  1854. 


BENNETT   (HENRY),  M.  D. 
A  PRACTICAL   TREATISE   ON  INFLAMMATION  OF  THE  UTERUS 

ITS  CERVIX  AND  APPENDAGES,  and  on  its  connection  with  Uterine  Disease.    Fourth 

American,  from  the  third  and  revised  London  edition.     In  one  neat  Octavo  volume,  of  430  pages 

with  wood-cuts.    (Now  Ready.) 

This  edition  will  be  found  materially  improved  over  its  predecessors,  the  author  having  carefully 
revised  it,  and  made  considerable  additions,  amounting  to  about  seventy-five  pages. 

This  edition  has  been  carefully  revised  and  altered,  ,  that  the  bulk  of  the  profession  are  not  fully  alive  to 
and  various  additions  have  been  made,  which  render  j  the  importance  and  frequency  of  the  disease  of  which 
it  more  complete,  and,  if  possible,  more  worthy  of  it  takes  cognizance.  The  present  edition  is  so  much 
the  high  appreciation  in  which  it  is  held  by  the  enlarged,  altered,  and  improved,  that  it  can  scarcely 

medical  profession  throughout  the  world.    A  copy     »»•  »A«.JJ« — i  »• ._       ^      ^ 

should  be  in  the  possession  of  every  physician. — 
Charleston  Med.  Journal  and  Review,  March,  1854. 

We  are  firmly  of  opinion  that  in  proportion  as  a 


knowledge  of  uterine  diseases  becomes  more  appre- 
eiated,  this  work  will  be  proportionably  established 
as  a  text-book  in  the  profession. — The  Lancet. 

When,  a  few  years  back,  the  first  edition  of  the 
present  work  was  published,  the  subject  was  one 
almost  entirely  unknown  to  the  obstetrical  celebrities 
of  the  day ;  and  even  now  we  have  reason  to  know 


be  considered  the  same  work.— Dr.  Ranking's  Ab- 
stract. 

Few  works  issue  from  the  medical  press  which 
are  at  once  original  and  sound  in  doctrine;  but  such, 
we  feel  assured,  is  the  admirable  treatise  now  before 
us.  The  important  practical  precepts  which  the 
author  inculcates  are  all  rigidly  deduced  from  facts. 
.  .  .  Every  page  of  the  book  is  good,  and  eminently 
practical.  ...  So  far  as  we  know  and  believe,  it  is 
the  best  work  on  the  subject  of  which  it  treats  — 
Montkly  Journal  of  Medital  Science. 


BLANCHARD   &   LEA'S   MEDICAL 


BEALE  (LIONEL   JOHN),  M.  R.  C.  S.,  &c. 
THE    LAWS   OF    HEALTH   IN    RELATION   TO    MIND    AND   BODY. 

A  Series  of  Letters  from  an  old  Practitioner  to  a  Patient.     In  one  handsome  volume,  royal  12mo., 
extra  cloth. 

BILLING    (ARCHIBALD),  M.  D. 

THE  PRINCIPLES  OF  MEDICINE.     Second  American,  from  the  Fifth  and 
Improved  London  edition.    In  one  handsome  octavo  volume,  extra  cloth,  250  pages. 


BLAKISTON    (PEYTON),  M.  D.,  F.  R.  S.,  &c. 
PRACTICAL    OBSERVATIONS    ON    CERTAIN    DISEASES    OF    THE 

CHEST,  and  on  the  Principles  of  Auscultation.    In  one  volume.  8vo.,  pp.  384. 


BURROWS    (GEORGE),  M.  D. 
ON  DISORDERS  OF  THE  CEREBRAL   CIRCULATION,  and  on  the  Con- 

nection  between  the  Affections  of  the  Brain  and  Diseases  of  the  Heart.     In  one  8vo.  vol.,  with 
colored  plates,  pp.  21t>. 

BUDD  (GEORGE),  M.  D.,  F.  R.  S., 

Professor  of  Medicine,  in  King's  College,  London. 

ON  DISEASES  OF  THE  LIVER.  Second  American,  from  the  second  and 
enlarged  London  edition.  In  one  very  handsome  octavo  volume,  with  four  beautifully  colored 
plates,  and  numerous  wood-cuts,  pp.  468.  New  edition.  (Just  Issued.) 

The  reputation  which  this  work  has  obtained  as  a  full  and  practical  treatise  on  an  important  class 
of  diseases  will  not  be  diminished  by  this  improved  and  enlarged  edition.  It  has  been  carefully  and 
thoroughly  revised  by  the  author;  the  number  of  plates  has  been  increased,  and  the  style  of  its  me- 
chanical execution  will  be  found  materially  improved. 


The  full  digest  we  have  given  of  the  new  matter 
introduced  into  the  present  volume,  is  evidence  of 
the  value  we  place  on  it.  The  fact  that  the  profes- 
sion has  required  a  second  edition  of  a  monograph 
such  as  that,  before  us,  bears  honorable  testimony 
to  its  usefulness.  For  many  years,  Dr.  Jiudd's 


work  must  be  the  authority  of  the  jrreat  mass  o) 
British  practitioners  on  the  hepatic  diseases  ;  and  it 
is  satisfactory  that  the  subject  has  been  taken  up  by 
so  able  and  experienced  a  physician. — British  ami 
Foreign  Medieo-Chirurgical  Review. 


BUCKLER  (T.  H.),  M.  D., 

Formerly  Physician  to  the  Baltimore  Almshouse  Infirmary,  &c. 

ON  THE  ETIOLOGY,   PATHOLOGY,  AND  TREATMENT  OF    FIBRO- 

BKONCH1TIS  AND  KHEUMATIC  PNEUMONIA.     In  one  handsome  octavo  volume,  extra 

doth.     (Now  Ready.) 

The  concluding  chapter  on  Treatment  is  full  of 
sound  practical  suggestions,  which  make  this  emi- 
nently a  book  to  be  prized  by  the  "  working  doctor" 


rather  than  the  mere  closet  student. — IV.  J.  Medical 


Reporter,  March,  1854. 


BLOOD  AND   URINE  (MANUALS  ON). 
BY  JOHN   WILLIAM   GRIFFITH,   G.  OWEN   REESE,   AND  ALFRED 

MARKWICK.     One  thick  volume,  royal  12mo.,  extra  cloth,  with  plates,    pp.  460. 

BRODIE  (SIR  BENJAMIN   C.),  M.  D.,  &c. 
CLINICAL  LECTURES  ON  SURGERY.     1  vol.  8vo.;  cloth.     ^50  pp. 

BY   THE    SAME    AUTHOR. 

SELECT  SURGICAL  WORKS,  1  vol.  8vo.  leather,  containing  Clinical  Lectures 

on  Surgery,  Diseases  of  the  Joints,  and  Diseases  of  the  Urinary  Organs. 


BIRD  (GOLDING),  A.  M.,  M.  D.,  &c. 
URINARY     DEPOSITS:     THEIR     DIAGNOSIS,    PATHOLOGY,    AND 

THERAPEUTICAL  INDICATIONS.     A  new  and  enlarged  American,  from  the  last  improved 
London  edition.    With  over  sixty  illustrations.     In  one  royal  12mo.  volume,  extra  cloth. 

The  new  edition  of  Dr.  Bird's  work,  though  not  I  suits  of  those  microscopical  and  chemical  researches 
increased  in  size,  has  been  greatly  modified,  and  I  regarding  the  physiology  and  pathology  of  the  uri- 
inuch  of  it  rewritten.  It  now  presents,  in  a  corn-  I  nary  secretion,  which  nave  contributed  so  much  to 


pendious  form,  the  gist  of  all  that  is  known  and  re 
liable  in  this  department.  From  its  terse  style  and 
ronvenient  size,  it  is  particularly  applicable  to  the 
student,  to  whom  we  cordially  commend  it. —  The 
Medical  Examiner. 

It  can  scarcely  be  necessary  for  us  to  say  anything 
of  the  merits  of  this  well-known  Treatise,  which  so 
admirably  brings  into  practical  application  the  re- 


the  increase  of  our  diagnostic  powers,  and  10  the 
extension  and  satisfactory  employment  of  our  thera- 
peutic resources.  In  the  preparation  of  this  new 
edition  of  his  work,  it  is  obvious  that  Dr.  Golding 
Bird  has  spared  no  pains  to  render  it  a  faithful  repre- 
sentation of  the  present  state  of  scientific  knowledge 
on  the  subject  it  embraces.—  The  British  and  Foreign 
Medic  o-Chirurgical  Review. 


BY   THE   SAME   ALTTHOR. 

ELEMENTS  OF  NATURAL  PHILOSOPHY;  being  an  Experimental  Intro- 
duction to  the  Physical  Sciences.  Illustrated  with  nearly  four  hundred  wood-cuts.  From  the 
third  London  edition.  In  one  neat  volume,  royal  12mo.  pp.  402. 


AND   SCIENTIFIC    PUBLICATIONS. 


BARTLETT  (ELISHA),  M.  D., 

Professor  of  Materia  Medica  and  Medical  Jurisprudence  in  the  College  of  Physicians  and 
Surgeons,  New  York. 

THE   HISTORY,  DIAGNOSIS,  AND  TREATMENT  OF  THE  FEVERS 

OF  THE  UNITED  STATES.    Third  edition,  revised  and  improved.    In  one  octavo  volume, 

of  six  hundred  pages,  beautifully  printed,  and  strongly  bound. 

In  preparing  a  new  edition  of  this  standard  work,  the  author  has  availed  himself  of  such  obser- 
vations and  investigations  as  have  appeared  since  the  publication  of  his  last  revision,  and  he  has 
endeavored  in  every  way  to  render  it  worthy  of  a  continuance  of  the  very  marked  favor  with  which 
it  has  been  hitherto  received. 


The  masterly  and  elegant  treatise,  by  Dr.  Bartlett 
is  invaluable  to  the  American  student  and  practi- 
tioner.—Dr.  Holmes's  Report  to  the  Nat,  Med.  Asso- 
ciation. 

We  regard  it,  from  the  examination  we  have  made 
of  it,  the  best  work  on  fevers  extant  in  our  language, 
and  as  such  cordially  recommend  it  to  the  medical 


Take  it  altogether,  it  is  the  most  com 
of  our  fevers  which   has  yet  been  pu 
every  practitioner  should  avail  himself  of  its  con- 
tent8.-«Tke  Western  Lancet. 


mpl«te  history 
ublished,  and 


Of  the  value  and  importance  of  such  a  work,  it  is 
needless  here  to  speak;  the  profession  of  the  United 
State*  owe  much  to  the  author  for  the  very  able 
volume  which  he  has  presented  to  them,  and  for  the 
careful  and  judicious  manner  in  which  he  has  exe- 
cuted his  task.  No  one  volume  with  which  we  are 
acquainted  contains  so  complete  a  history  of  our 
fevers  as  this.  To  Dr.  Bartlett  we  owe  our  best 


public. — St.  Louis  Medical  and  Surgical  Journal. 

thanks  for  the  very  able  volume  he  has  given  us,  as 


embodying  certainly  the  most  complete,  methodical, 
and  satisfactory  account  of  our  fevers  anywhere  to 
be  met  with.—  The  Charleston  Med.  Journal  and 
Review. 


BOWMAN  (JOHN   E.),  M.D. 
PRACTICAL   HANDBOOK   OF   MEDICAL    CHEMISTRY.     In  one  neat 

volume,  royal  12mo.,  with  numerous  illustrations,    pp.  288. 

BY  THE  SAME  AUTHOR. 

INTRODUCTION    TO    PRACTICAL    CHEMISTRY,    INCLUDING    ANA- 

LYSIS.    With  numerous  illustrations.    In  one  neat  volume,  royal  12mo.    ppf350. 


BARLOW   (GEORGE  HJ,   M.D. 
A  MANUAL  OF  THE  PRINCIPLES  AND  PRACTICE   OF  MEDICINE. 

In  one  octavo  volume.     (Preparing.) 

CYCLOPAEDIA    OF    PRACTICAL    MEDICINE. 

Edited  by  DUNGLISON,  FORBES,  TWEEDIE,  and  CONOLLY,  in  four  large  octavo 
volumes,  strongly  bound.     j§^"  See  DUNGLISON. 

; 

COLOMBAT  DE  L'ISERE. 
A  TREATISE   ON   THE    DISEASES    OF   FEMALES,  and  on  the  Special 

Hygiene  of  their  Sex.    Translated,  with  many  Notes  and  Additions,  by  C.  D.  MEIGS,  M.  D. 

Second  edition,  revised  and  improved.     la  one  large  volume,  octavo,  with  numerous  wood-cuts. 

pp.  720. 

The  treatise  of  M.  Colombat  is  a  learned  and  la-  |  M.  Colombat  De  LTsere  has  not  consecrated  ten 
borious  commentary  on  these  diseases,  indicating  i  years  of  studious  toil  and  research  to  the  frailer  sex 
very  considerable  research,  great  accuracy  of  judg-  >  in  vain  ;  and  although  we  regret  to  hear  it  is  at  the 
ment,  and  no  inconsiderable  personal  experience.  ,  expense  of  health,  he  has  imposed  a  debt  of  gratitude 
With  the  copious  notes  and  additions  of  its  experi-  as  well  upon  the  profession,  as  upon  the  mothers  and 
enced  and  very  erudite  translator  and  editor,  Dr.  j  daughters  of  beautiful  France,  which  that  gallant 
Meigs,  it  presents,  probably,  one  of  the  most  corn-  nation  knows  best  how  to  acknowledge. — New  Or- 
plete  and  comprehensive  works  on  the  subject  we  leans  Medical  Journal. 
possess. — American  Med.  Journal. 


COPLAND  (JAMES),  M.  D.,  F.  R.  S.,  &c. 
OF  THE  CAUSES,  NATURE,  AND  TREATMENT  OF  PALSY  AND 

APOPLEXY,  and  of  the  Forms,  Seats,  Complications,  and  Morbid  Relations  oi  Paralytic  and 
Apoplectic  Diseases.     In  one  volume,  royal  12mo.,  extra  cloth,    pp.  326. 


CHAPMAN  (PROFESSOR  N.),  M.  D.,  &c. 
LECTURES    ON    FEVERS,   DROPSY,    GOUT,   RHEUMATISM,   &c.  &c. 

In  one  neat  8vo.  volume,    pp.  450. 

CLYMER  (MEREDITH),  M.  D.,  &c. 
FEVERS;     THEIR    DIAGNOSIS,    PATHOLOGY,    AND    TREATMENT. 

Prepared  and  Edited,  with  large  Additions,  from  the  Essays  on  Fever  in  Tweedie's  Library  oi 
Practical  Medicine.     In  one  octavo  volume,  of  600  pages. 


CARSON  (JOSEPH),  M.  D., 

Professor  of  Materia  Medica  and  Pharmacy  in  the  University  of  Pennsylvania. 

SYNOPSIS  OF  THE  COURSE  OF  LECTURES  Otf  MATERIA  MEDICA 

AND  PHARMACY,  delivered  in  the  University  of  Pennsylvania.    In  one  very  neat  octavo 
volume,  of  208  pages. 


BLANCHARD  &  LEA'S   MEDICAL 


CARPENTER  (WILLIAM    B.),  M.  D.,  F.  R.  S.,  &c., 

Examiner  in  Physiology  and  Comparative  Anatomy  in  the  University  of  London. 

PRINCIPLES  OF  HUMAN  PHYSIOLOGY;  with  their  chief  applications  to 

Psychology,  Pathology,  Therapeutics,  Hygiene,  and  Forensic  Medicine.  Fifth  American,  from 
'  the"  fourth  and  enlarged  London  edition.  With  three  hundred  and  fourteen  illustrations.  Edited, 
with  additions,  by  FRANCIS  GURNEY  SMITH,  M.  D.,  Professor  of  the  Institutes  of  Medicine  in  the 
Pennsylvania  Medical  College,  &c.  In  one  very  large  and  beautiful  octavo  volume,  of  about  1100 
large  pages,  handsomely  printed  and  strongly  bound  in  leather,  with  raised  bands.  New  edition. 
(Lately  Issued.) 

This  edition  has  been  printed  from  sheets  prepared  for  the  purpose  by  the  author,  who  has 
introduced  nearly  one  hundred  illustrations  not  in  the  London  edition ;  while  it  has  also  enjoyed 
the  advantage  of  a  careful  superintendence^on  the  part  of  the  editor,  who  has  added  notices  of  .^uch 
more  recent  investigations  as  had  escaped  the  author's  attention.  Neither  care  nor  expense  has 
been  spared  in  the  mechanical  execution  of  the  work  to  render  it  superior  to  former  editions,  and  it 
is  confidently  presented  as  in  every  way  one  of  the  handsomest  volumes  as  yet  placed  before  the 
medical  profession  in  this  country. 

The  most  complete  work  on  the  science  in  our  j  The  best  text-book  in  the  language  on  this  ex- 
language. — Am.  Med.  Journal.  j  tensive  subject. — London  Med.  Times. 

The  most  complete  exposition  of  physiology  which  i      A  complete  cyclopaedia  of  this  branch  of  science, 
any  language  can  at  present  give.— Brit,  and  For.    " "•  *•  Med-  Times. 
Mzd.-Chirurg.  Review. 


We  have  thus  adverted  to  some  of  the  leading 
additions  and  alterations,"  which  have  been  in- 


The  standard  of  authority  on  physiological  sub- 
jects. *  #  *  In  the  present  edition,  to  particularize 
the  alterations  and  additions  which  have  been  made, 
would  require  a  review  of  the  whole  work,  since 


troduced  by  the  author  into  this  edition  of  his  phy-  I  scarcely  a  subject  has  not  been  revised  and  altered, 
siology.  These  will  be  found,  however,  very  far  to  i  added  to,  or  entirely  remodelled  to  adapt  it  to  the 
exceed  the  ordinary  limits  of  a  new  edition,  "  the  I  present  state  of  the  science.— Charleston  Med.  Journ. 


old  materials  having  been  incorporated  with  the 
new,  rather  than  the  new  with  the  old."  It  now 
certainly  presents  th£  most  complete  treatise  on  the 
subject  within  the  Teach  of  the  American  reader; 
and  while,  for  availability  as  a  text-book,  we  may 
perhaps  regret  its  growth  in  bulk,  we  are  sure  that 
the  student  of  physiology  will  feel  the  impossibility 
of  presenting  a  thorough  digest  of  the  facts  of  the 


language. — Stethoscope. 

The  most  complete  work  now  extant  in  our  lan- 
guage.— N.  O.  Med.  Register. 


Any  reader  who  desires  a  treatise  on 
may  feel   himself  entirely  safe  in  ordering  this.— 
Western  Med.  and  Surg.  Journal. 

From  this  hasty  and  imperfect  allusion  it  will  be 
seen  by  our  readers  that  the  alterations  and  addi- 
tions to  this  edition  render  it  almost  a  new  work — 
and  we  can  assure  our  readers  that  it  is  one  of  the 
best  summaries  of  the  existing  facts  of  i 


science  witnin  a  more  limited  compass.— Medical    best  summaries  of  the  existing  facts  of  physiological 
Examiner.  science  within  the  reach  of  the  English  student  and 

physician. — N.  Y.  Journal  of  Medicine. 
The  greatest,  the  most  reliable,  and  the  best  book 
on  the  subject  which  we  know  of  in  the  English 


The  profession  of  this  country,  and  perhaps  also 
of  Europe,  have  anxiously  and  for  some  time  awaited 
the  announcement  of  this  new  edition  of  Carpenter's 
Human  Physiology.  His  former  editions  have  for 
many  years  been  almost  the  only  text-book  on  Phy- 
siology in  all  our  medical  schools,  and  its  circula- 
tion among  the  profession  has  been  unsurpassed  by 
any  work  in  any  department  of  medical  science. 

It  is  quite  unnecessary  for  us  to  speak  of  this 
work  as  its  merits  would  justify.  The  mere  an- 


The  changes  are  too  numerous  to  admit  of  an  ex- 
tended notice  in  this  place.  At  every  point  where 
the  recent  diligent  labors  of  organic  chemists  and 
micrographers  have  furnished  interesting  and  valu- 
able facts,  they  have  been  appropriated,  and  no  pains  [  nouncement  of  its  appearance  will' afford  the  highest 
have  been  spared,  in  so  incorporating  and  arranging  pleasure  to  every  student  of  Physiology,  while  its 
them  that  the  work  may  constitute  one  harmonious  perusal  will  be  of  infinite  service  in  advancing 
system. — Southern  Med.  and  Surg.  Journal.  '  physiological  science. — Ohio  Med.  and  Surg.  Journ. 

BY   THE   SAME   AUTHOR.      (In  PretS.) 

PRINCIPLES    OF    GENERAL    AND    COMPARATIVE    PHYSIOLOGY. 

Intended  as  an  Introduction  to  the  Study  of  Human  Physiology;  and  as  a  Guide  to  the  Philo- 
sophical pursuit  of  Natural  History.  New  and  improved  edition.  In  one  large  and  handsome 
octavo  volume,  with  several  hundred  beautiful  illustrations. 

The  very  thorough  revision,  and  extensive  alterations  made  by  the  author,  have  caused  a  delay 
in  the  promised  appearance  of  this  work.  It  is  now,  however,  at  press,  and  may  be  expected  for 
publication  during  the  ensuing  summer.  A  very  large  number  of  new  and  important  illustrations 
nave  been  prepared  for  it,  and  the  publishers  trust  to  render  the  volume  worthy  of  its  extended 
reputation  in  every  point  of  typographical  finish,  as  one  of  the  handsomest  productions  of  the 
American  press.  A  few  notices  of  the  former  edition  are  appended. 

critical,  and  unprejudiced  view  of  those  labors  and 
of  combining  the  varied,  heterogeneous  materials  at 
his  disposal,  so  as  to  form  an  harmonious  whole. 
We  feel  that  this  abstract  can  give  the  reader  a  very 
imperfect  idea  of  the  fulness  of  this  work,  and  no 
idea  of  its  unity,  of  the  admirable  manner  in  which 
material  has  been  brought,  from  the  most  various 
sources,  to  conduce  to  its  completeness,  of  the  lucid- 
ity of  the  reasoning  it  contains,  or  of  the  clearness 
of  language  in  which  the  whole  is  clothed.  Not  the 
profession  only,  but  the  scientific  world  at  large, 
must  feel  deeply  indebted  to  Dr.  Carpenter  for  this 
great  work.  It  must,  indeed,  add  largely  even  to 
his  high  reputation. — Medical  Times. 


Without  pretending  to  it,  it  is  an  Encyclopedia  of 
the  subject,  accurate  and  complete  in  all  respects — 
a  truthful  reflection  of  the  advanced  state  at  which 
the  science  has  .now  arrived. — Dublin  Quarterly 
Journal  of  Medical  Science. 

A  truly  magnificent  work— in  itself  a  perfect  phy- 
siological study. — Ranking's  Abstract. 

This  work  stands  without  its  fellow.  It  is  one 
few  men  in  Europe  could  have  undertaken  ;  it  is  one 
no  man,  we  believe,  could  have  brought  to  so  suc- 
cessful an  issue  as  Dr.  Carpenter,  ft  required  for 
its  production  a  physiologist  at  once  deeply  read  in 
the  labors  of  others,  capable  of  taking  a  general, 


BY  THE  SAME  AUTHOR.     (Preparing.) 

THE  MICROSCOPE  AND  ITS  REVELATIONS.     In  one  handsome  volume, 

beautifully  illustrated  with  plates  and  wood-cuts. 


AND   SCIENTIFIC   PUBLICATIONS. 


CARPENTER  (WILLIAM  B.),   M.  D.,  F.  R.  S., 

Examiner  in  Physiology  and  Comparative  Anatomy  in  the  University  of  London. 

ELEMENTS  (OK  MANUAL)  OF  PHYSIOLOGY,  INCLUDING  PHYSIO- 
LOGICAL ANATOMY.  Second  American,  from  a  new  and  revised  London  edition.  With 
one  hundred  and  ninety  illustrations.  In  one  very  handsome  octavo  volume. 

In  publishing  the  first  edition  of  this  work,  its  title  was  altered  from  that  of  the  London  volume, 
by  the  substitution  of  the  word  "Elements7'  for  that  of  "  Manual,"  and  with  the  author's  sanction 
the  title  of  "  Elements"  is  still  retained  as  being  more  expressive  of  the  scope  of  the  treatise.  A 
comparison  of  the  present  edition  with  the  former  one  will  show  a  material  improvement,  the 
author  having  revised  it  thoroughly,  with  a  view  of  rendering  it  complete4y  on  a  level  with  the 
most  advanced  state  of  the  science.  By  condensing  the  less  important  portions,  these  numerous 
additions  have  been  introduced  without  materially  increasing  the  bulk  of  the  volume,  and  while 
numerous  illustrations  have  been  added,  and  the  general  execution  of  the  work  improved,  it  has 
been  kept  at  its  former  very  moderate  price. 

The  best  and  most  complete  eapose"  of  modern 
Physiology,  in  one  volume,  extant  in  the  English 
language.— St.  Louis  Medical  Journal. 


To  say  that  it  is  the  hest  manual  of  Physiology 
now  before  the  public,  would  not  do  sufficient  justice 
to  the  author.— B uffalo  Medical  Journal. 

la  his  former  works  it  would  seem  that  he  had 
exhausted  the  subject  of  Physiology.  In  the  present, 
hegives  the  essence,  as  it  were,  of  the  whole. — N.  Y. 
Journal  of  Medicine. 

Those  who  have  occasion  for  an  elementary  trea- 
tise on  Physiology,  cannot  do  better  than  to  possess 
themselves  of  the  manual  of  Dr.  Carpenter. — Medical 
Examiner. 


With  such  an  aid  in  his  hand,  there  is  no  excuse 
for  the  ignorance  often  displayed  respecting  the  sub- 
jects of  which  it  treats.  From  its  unpretending  di- 
mensions, it  may  not  be  so  esteemed  by  those  anxious 
to  make  a  parade  of  their  erudition;  but  whoever 
masters  its  contents  will  have  reason  to  be  proud  of 


his  physiological  acquirements.    The  illustrations 
are  well  selected  and  finely  executed.— i 


Press. 


-Dublin  Med. 


BY   THE  SAME   AUTHOR. 


A  PRIZE  ESSAY  ON  THE  USE  OF  ALCOHOLIC  LIQUORS  IN  HEALTH 

AND  DISEASE.    New  edition,  with  a  Preface  by  D.  F.  CONDIE,  M.  D.,  and  explanations  of 
scientific  words.    In  one  neat  12mo.  volume.     (Now  Ready.) 

This  new  edition  has  been  prepared  with  a  view  to  an  extended  circulation  of  this  important  little 
work,  which  is  universally  recognized  as  the  best  exponent  of  the  laws  of  physiology  and  pathology 
applied  to  the  subject  of  intoxicating  liquors,  in  a  form  suited  both  for  the  profession  and  the  public. 
To  secure  a  wider  dissemination  of  its  doctrines  the  publishers  have  done  up  copies  in  flexible 
cloth,  suitable  for  mailing,  which  will  be  forwarded  through  the  post-office,  free,  on  receipt  of  fifty 
cents.  Societies  and  others  supplied  in  quantities  for  distribution  at  a  liberal  deduction. 


CHELIUS  (J.  M.),   M.  D., 
Professor  of  Surgery  in  the  University  of  Heidelberg,  &a. 

A  SYSTEM  OF  SURGERY.     Translated  from  the  German,  and  accompanied 

with  additional  Notes  and  References,  by  JOHN  F.  SOUTH.     Complete  in  three  very  large  octavo 
volumes,  of  nearly  2200  pages,  strongly  bound,  with  raised  bands  and  double  titles. 

We  do  not  hesitate  to  pronounce  it  the  best  and 
most  comprehensive  system  of  modern  surgery  with 
which  we  are  acquainted.— Medico-C  fiirurgical  Re- 


The  fullest  and  ablest  digest  extant  of  all  that  re- 
lates to  the  present  advanced  state  of  surgical  pa- 
thology.— American  Medical  Journal. 

As  complete  as  any  system  of  Surgery  can  well 
be. — Southern  Medical  and  SurgicalJournal. 


The  most  learned  and  complete  systematic  treatise 
now  extant. — Edinburgh  Medical  Journal. 

A  complete  encyclopaedia  of  surgical  science — a 
very  complete  surgical  library — by  far  the  most 
complete  and  scientific  system  of  surgery  in  the 
English  language.— N.  Y.  Journal  of  Medicine. 

The  most  extensive  and  comprehensive  account  of 
the  art  and  science  of  Surgery  in  our  language. — 
Lancet. 


CHRISTISON  (ROBERT),  M.  D.,  V.  P.  R.  S.  E.,  fcc. 

A  DISPENSATORY;  or.  Commentary  on  the  Pharmacopeias  of  Great  Britain 
and  the  United  States;  comprising  the  Natural  History,  Description,  Chemistry,  Pharmacy,  Ac- 
tions, Uses,  and  Doses  of  the  Articles  of  the  Materia  Medica.  Second  edition,  revised  and  ira- 

important  New  Remedies.  Witfi  copious  Addi- 
avings.  By  R.  EGLESFELD  GRIFFITH,  M.  D. 
over  1000  pages. 

There  is  not  in  any  language  a  more  complete  aad 
perfect  Treatise.— N.  Y.  Annalist. 

In  conclusion,  we  need  scarcely  say  that  we 
strongly  recommend  this  work  to  all  classes  of  our 
readers.  As  a  Dispensatory  and  commentary  on  the 
Pharmacopoeias,  it  is  unrivalled  in  the  English  or 
any  other  language.— The  Dublin  Quarterly  Journal . 

We  earnestlyyjeoommend  Dr.  Christison's  Dis- 
pensatory to  air  our  readers,  as  an  indispensable 


It  is  not  needful  that  we  should  compare  it  with 
the  other  pharmacopeias  extant,  which  enjoy  and 
merit  the  confidence  of  the  profession  :  it  is  enough 
to  say  that  it  appears  to  us  as  perfect  as  a  Dispensa- 
tory, in  the  present  state  of  pharmaceutical  science, 
could  be  made.  If  it  omits  any  details  pertaining  to 
this  branch  of  knowledge  which  the  student  has  a 
right  to  expect  in  such  a  work,  we  confess  the  omis- 
sion has  escaped  our  scrutiny.  We  cordially  recom- 
mend this  work  to  such  of  our  readers  as  are  in  need 
of  a  Dispensatory.  They  cannot  make  choice  of  a 
better-Western  Journ.  of  Medicine  a.nd  Surgery. 


companion,  not  in  the  Study  only,  but  in  the  Surgery 
also. — British  and  Foreign  Medical  Review. 


8 


BLANCHARD  &  LEA'S  MEDICAL 


CONDIE  (D.  F.),  M.  D.,  &c. 
A  PRACTICAL  TREATISE  ON  THE  DISEASES  OF  CHILDREN.    Fourth 

edition,  revised  and  augmented.  In  one  large  volume,  8vo.,  of  nearly  750  pages.  (Just  Issued.) 
FROM  THE  AUTHOR'S  PREFACE. 

The  demand  for  another  edition  has  afforded  the  author  an  opportunity  of  again  subjecting  the 
entire  treatise  to  a  careful  revision,  and  of  incorporating  in  it  every  important  observation  recorded 
since  the  appearance  of  the  last  edition,  in  reference  to  the  pathology  and  therapeutics  of  the  several 
diseases  of  which  it  treats. 

In  the  preparation  of  the  present  edition,  as  in  those  which  have  preceded,  while  the  author  has 
appropriated  to  his  use  every  important  fact  that  he  has  found  recorded  in  the  works  of  others, 
having  a  direct  bearing  upon  either  of  the  subjects  of  which  he  treats,  and  the  numerous  valuable 
observations — pathological  as  well  as  practical — dispersed  throughout  the  pages  of  the  medical 
journals  of  Europe  and  America,  he  has,  nevertheless,  relied  chiefly  upon  his  own  observations  and 
experience,  acquired  during  a  long  and  somewhat  extensive  practice,  and  under  circumstances  pe- 
culiarly well  adapted  for  the  clinical  study  of  the  diseases  of  early  life. 

Every  species  of  hypothetical  reasoning  has,  as  much  as  possible,  been  avoided.  The  author  has 
endeavored  throughout  the  work  to  confine  himself  to  a  simple  statement  of  well-ascertained  patho- 
logical facts,  and  plain  therapeutical  directions — his  chief  desire  being  to  render  it  what  its  title 
imports  it  to  be,  A  PRACTICAL  TREATISE  ON  THE  DISEASES  OF  CHILDREN. 

We  feel  assured  from  actual  experience  that  no 
physician's  library  can  be  complete  without  a  copy 
of  this  work. — N.  Y.  Journal  of  Medicine. 

A  veritable  psediatric  encyclopaedia,  and  an  honor 
to  American  medical  literature. — Ohio  Medical  and 
Surgical  Journal. 

We  feel  persuaded  that  the  American  medical  pro- 
fession will  soon  regard  it  not  only  ns  a  very  good, 
but  as  the  VERY  BEST  "  Practical  Treatise  on  the 
Diseases  of  Children." — American  Medical  Journal. 

We  pronounced  the  first  edition  to  be  the  best 
work  on  the  diseases  of  children  in  the  English 
language,  and,  notwithstanding  all  that  has  been 
published,  we  still  regard  it  in  that  light. — Medical 
Examiner. 


Dr.  Condie's  scholarship,  acumen?  industry,  and 
practical  sense  are  manifested  in  this,  as  in  all  his 
numerous  contributions  to  science. — Dr.  Holmes' s 
Report  to  the  American  Medical  Association. 

Taken  as  a  whole,  in  our  judgment,  Dr.  Condie's 
Treatise  is  the  one  from  the  perusal  of  which  the 
practitioner  in  this  country  will  rise  with  the  great- 
est satisfaction  — Western  Journal  of  Medicine  and 
Surgery. 

One  of  the  best  works  upon  the  Diseases  of  Chil- 
dren in  the  English  language. — Western  Lancet. 

Perhaps  the  most  full  and  complete  work  now  be- 
fore the  profession  of  the  United  States;  indeed,  we 
may  say  in  the  English  language.  It  is  vastly  supe- 
rior to  most  of  its  predecessors. — Transylvania  Med. 
Journal. 


COOPER  (BRANSBY   B.),  F.  R.  S., 

Senior  Surgeon  to  Guy's  Hospital,  &c.  • 

LECTURES  ON  THE   PRINCIPLES  AND   PRACTICE   OF   SURGERY. 

In  one  very  large  octavo  volume,  of  750  pages.    (Lately  Issued). 

For  twenty-five  years  Mr.  Bransby  Cooper  has  I  Cooper's  Lectures  as  a  most  valuable  addition  to 
been  surgeon  to  Guy's  Hospital;  and  the  volume  |  our  surgical  literature,  and  one  which  cannot  fail 
before  us  may  be  said  to  consist  of  an  account  of  to  be  of  service  both  to  students  and  to  those  Avho 
the  results  of  his  surgical  experience  during  that  are  actively  engaged  in  the  practice  of  their  profes- 
long  period  We  cordially  recommend  Mr.  Bransby  I  sion. — The  Lancet. 


COOPER  (SIR  ASTLEY   P.),   F.  R.  S.,  &c. 
A  TREATISE  ON  DISLOCATIONS  AND  FRACTURES  OF  THE  JOINTS. 

Edited  by  BRANSBY  B.  COOPER,  F.  R.  S.,  &c.  With  additional  Observations  by  Prof.  J.  C. 
WARREN.  A  new  American  edition.  In  one  handsome  octavo  volume,  with  numerous  illustra- 
tions on  wood. 


BY  THE   SAME   AUTHOR. 

ON  THE  ANATOMY  AND  TREATMENT  OF  ABDOMINAL  HERNIA. 

One  large  volume,  imperial  8vo.,  with  over  130  lithographic  figures. 

BY   THE   SAME   AUTHOR. 

ON   THE   STRUCTURE  AND  DISEASES   OF  THE  TESTIS,  AND  ON 

THE  THYMUS  GLAND.    One  vol.  imperial  8vo.,  with  177  figures,  on  29  plates. 


BY   THE   SAME    AUTHOR. 


ON  THE  ANATOMY  AND  DISEASES   OF  THE   BREAST,  with  twenty- 

five  Miscellaneous  and  Surgical  Papers.    One  large  volume,  imperial  8vo.,  with  252  figures,  on 

36  plates. 

These  last  three  volumes  complete  the  surgical  writings  of  Sir  Astley  Cooper.  They  are  very 
handsomely  printed,  with  a  large  number  of  lithographic  plates,  executed  in  the  best  style,  and  are 
presented  at  exceedingly  low  prices. 


AND   SCIENTIFIC   PUBLICATIONS. 


CHURCHILL  (FLEETWOOD),  M.  D.,  M.  R.  I.  A. 
ON  THE  THEORY  AND  PRACTICE  OF  MIDWIFERY.  A  new  American, 

from  the  last  and  improved  English  edition.  Edited,  with  Notes  and  Additions,  by  D.  FRANCIS 
CONDIE,  M.  D.,  author  of  a  "Practical  Treatise  on  the  Diseases  of  Children,"  &c.  With  139 
illustrations.  In  one  very  handsome  octavo  volume,  pp.  510.  (Lately  Issued.) 


To  bestow  praise  on  a  book  that  has  received  such 
marked  approbation  would  be  superfluous.  We  need 
only  say,  therefore,  that  if  the  first  edition  was 
thought  worthy  of  a  favorable  reception  by  the 
medical  public,  we  can  confidently  affirm  that  this 
will  be  found  much  more  eo.  The  lecturer,  the 
practitioner,  and  the  student,  may  all  have  recourse 
to  its  pages,  and  derive  from  their  perusal  much  in- 
terest and  instruction  in  everything  relating  to  theo- 
retical and  practical  midwifery.— Dublin  Quarterly 
Journal  of  Medical  Science. 

A  work  of  very  great  merit,  and  such  as  we  can 
confidently  recommend  to  the  study  of  every  obste- 
tric practitioner.— London  Medical  Gazette. 

This  is  certainly  the  most  perfect  system  extant. 
It  is  the  best  adapted  for  the  purposes  of  a  text- 
book, and  that  which  he  whose  necessities  confine 
him  to  one  book,  should  select  in  preference  to  all 
others.— Southern  Medical  and  Surgical  Journal. 

The  most  popular  work  on  midwifery  ever  issued 
from  the  American  press.— Charleston  Med.  Journal. 

Were  we  reduced  to  the  necessity  of  having  but 
one  work  on  midwifery,  and  permitted  to  choose, 
we  would  unhesitatingly  take  Churchill.— Western 
Med.  and  Surg.  .Journal. 

It  is  impossible  to  conceive  a  more  useful  and 
elegant  manual  than  Dr.  Churchill's  Practice  of 
Midwifery. — Provincial  Medical  Journal. 

Certainly,  in  our  opinion,  the  very  best  work  on 
the  subject  which  exists.— N.  Y.  Annalist. 


No  work  holds  a  higher  position,  or  is  more  de- 
serving of  being  placed  in  the  hands  of  the  tyro, 
the  advanced  student,  or  the  practitioner. — Medical 
Examiner. 

Previous  editions,  under  the  editorial  supervision 
of  Prof  R.  M.  Huston,  have  been  received  with 
marked  favor,  and  they  deserved  it;  but  this,  re- 
printed from  a  very  late  Dublin  edition,  carefully 
revised  and  brought  up  by  the  author  to  the  present 
time,  does  present  an  unusually  accurate  and  able 
exposition  of  every  important  particular  embraced 
in  the  department  of  midwifery.  *  *  The  clearness, 
directness,  and  precision  of  its  teachings,  together 
with  the  great  amount  of  statistical  research  which 
its  text  exhibits,  have  served  to  place  it  already  in 
the  foremost  rank  of  works  in  this  department  of  re- 
medial science. — N.  O.  Med.  and  Surg.  Journal. 

In  our  opinion,  it  forms  one  of  the  best  if  not  the 
very  best  text-book  and  epitome  of  obstetric  science 
which  we  at  present  possess  in  the  English  lan- 
guage.— Monthly  Journal  of  Medical  Science. 

The  clearness  and  precision  of  style  in  which  it  is 
written,  and  the  great  amount  of  statistical  research 
which  it  contains,  have  served  to  place  it  in  the  first 
rank  of  works  in  this  departmentof  medical  science. 
—  N.  Y.  Journal  of  Medicine. 

Few  treatises  will  be  found  better  adapted  as  a 
text-book  for  the  student,  or  as  a  manual  for  the 
frequent  consultation  of  the  young  practitioner. — 
American  Medical  Journal. 


BY   THE   SAME   AUTHOR. 


ON  THE  DISEASES  OF  INFANTS  AND  CHILDREN.     In  one  large  and 

handsome  volume  of  over  600  pages. 


We  regard  this  volume  as  possessing  more  claims 
to  completeness  than  any  other  of  the  kind  with 
which  we  are  acquainted.  Most  cordially  and  earn- 
estly, therefore,  do  we  commend  it  to  our  profession- 
al brethren,  and  we  feel  assured  that  the  stamp  of 
their  approbation  will  indue  time  be  impressed  upon 
it.  After  an  attentive  perusal  of  its  contents,  we 
hesitate  not  to  say,  that  it  is  one  of  the  most  com- 
prehensive ever  written  upon  the  diseases  of  chil- 
dren, and  that,  for  copiousness  of  reference,  extent  of 
research,  and  perspicuity  of  detail,  it  is  scarcely  to 
be  equalled,  and  not  to  be  excelled,  in  any  lan- 
guage.— Dublin  Quarterly  Journal. 

After  this  meagre,  and  we  know,  very  imperfect 
notice  of  Dr.  Churchill's  work,  we  shall  conclude 
by  saying,  that  it  is  one  that  cannot  fail  from  its  co- 
piousness, extensive  research,  and  general  accuracy, 
to  exalt  still  higher  the  reputation  of  the  author  in 
this  country.  The  American  reader  will  be  particu- 
larly pleased  to  find  that  Dr.  Churchill  has  done  full 
justice  throughout  his  work  to  the  various  A  merican 
authors  on  this  subject.  The  names  of  Dewees, 
Eberle,  Condie,  and  Stewart,  occur  on  nearly  every 
page,  and  these  authors  are  constantly  referred  to  by 
the  author  in  terms  of  the  highest  praise,  and  with 
the  most  liberal  courtesy. — The  Medical  Examiner. 


The  present  volume  will  sustain  the  reputation 
acquired  by  the  author  from  his  previous  works. 
The  reader  will  find  in  it  full  and  judicious  direc- 
tions for  the  management  of  infants  at  birth,  and  a 
compendious,  but  clear  account  of  the  diseases  to 
which  children  are  liable,  and  the  most  successful 
mode  of  treating  them.  We  must  not  close  this  no- 
tice without  calling  attention  to  the  author's  style, 
which  is  perspicuous  and  polished  to  a  degree,  we 
regret  to  say,  not  generally  characteristic  of  medical 
works.  We  recommend  the  work  of  Dr.  Churchill 
most  cordially,  both  to  students  and  practitioners, 
as  a  valuable  and  reliable  guide  in  the  treatment  of 
the  diseases  of  children. — Am.  Journ.  of  the  Med. 
Sciences. 

We  know  of  no  work  on  this  department  of  Prac- 
tical Medicine  which  presents  so  candid  and  unpre- 
judiced a  statement  or  posting  up  of  our  actual 
knowledge  as  this. — N.  Y.  Journal  of  Medicine. 

Its  claims  to  merit  both  as  a  scientific  and  practi- 
cal work,  are  of  the  highest  order.  Whilst  we 
would  not  elevate  it  above  every  other  treatise  on 
the  same  subject,  we  certainly  believe  that  very  few 
are  equal  to  it,  and  none  superior. — Southern  Med. 
and  Surgical  Journal. 


BY   THE   SAME  AUTHOR. 


ESSAYS  ON  THE  PUERPERAL  FEVER,  AND  OTHER  DISEASES  PE- 
CULIAR TO  WOMEN.  Selected  from  the  writings  of  British  Authors  previous  to  the  close  of 
the  Eighteenth  Century.  In  one  neat  octavo  volume,  of  about  four  hundred  and  fifty  pages. 


To  these  papers  Dr.  Churchill  has  appended  notes, 
embodying  whatever  information  has  been  laid  be- 
fore the  profession  since  their  authors'  time.  He  has 
also  prefixed  to  the  Essays  on  Puerperal  Fever, 
which  occupy  the  larger  portion  of  the  volume,  an 
interesting  historical  sketch  of  the  principal  epi- 


demics of  that  disease.  The  whole  forms  a  very 
valuable  collection  of  papers,  by  professional  writers 
of  eminence,  on  some  of  the  most  important  accidents 
to  which  the  puerperal  female  is  liable. — American 
Journal  of  Medical  Sciences. 


10 


BLANCHARD   &   LEA'S    MEDICAL 


CHURCHILL  (FLEETWOOD),    M.  D.,  M.  R.  I.  A.,    &c. 

ON  THE  DISEASES  OF  WOMEN;  including  those  of  Pregnancy  and  Child- 
bed.  A  new  American  edition,  revised  by  the  Author.  With  Notes  and  Additions,  by  D  FRAN- 
CIS CONDIE,  M.  D.,  author  of  "  A  Practical  Treatise  on  the  Diseases  of  Children."  In  one  large 
and  handsome  octavo  volume,  with  wood-cuts,  pp.  684.  (Just  Issued.) 

From  the  Aiithor^s  Preface. 

In  reviewing  this  edition,  at  the  request  of  my  American  publishers,  I  have  inserted  several  new 
sections  and  chapters,  and  I  have  added,  I  believe,  all  the  information  we  have  derived  from  recent 
researches ;  in  addition  to  which  the  publishers  have  been  fortunate  enough  to  secure  the  services 
of  an  able  and  highly  esteemed  editor  in  Dr.  Condie. 


"\Venow  regretfully  take  leave  of  Dr.  Churchill's 
book.  Had  our  typographical  limits  permitted,  we 
should  gladly  have  borrowed  more  from  its  richly 
stored  pages.  In  conclusion,  we  heartily  recom- 
mend it  to  the  profession,  and  would  at  the  same 
time  express  our  firm  conviction  that  it  will  not  only 
add  to  the  reputation  of  its  author,  but  will  prove  a 
work  of  great  and  extensive  utility  to  obstetric 
practitioners. — Dublin  Medical  Press. 

Former  editions  of  this  work  have  been  noticed  in 
previous  numbers  of  the  Journal.  The  sentiments  of 
high  commendation  expressed  in  those  notices,  have 
only  to  be  repeated  in  this;  not  from  the  fact  that 
the  profession  at  large  are  not  aware  of  the  high 
merits  which  this  work  really  possesses,  but  from  a 
desire  to  see  the  principles  and  doctrines  therein 
contained  more  generally  recognized,  and  more  uni- 
versally carried  out  in  practice. — N.  Y.  Journal  of 
Medicine. 

We  know  of  no  author  who  deserves  that  appro- 
bation, on  "the  diseases  of  females,"  to  the  same 
extent  that  Dr.  Churchill  does.  His,  indeed,  is  the 
only  thorough  treatise  we  know  of  on  the  subject; 
and  it  may  be  commended  to  practitioners  and  stu- 
dents as  a  masterpiece  in  its  particular  department. 
The  former  editions  of  this  work  have  been  com- 
mended strongly  in  this  journal,  and  they  have  won 
their  way  to  an  extended,  and  a  well-deserved  popu- 


larity. This  fifth  edition,  before  us.  is  well  calcu- 
lated to  maintain  Dr.  Churchill's  high  reputation. 
It  was  revised  and  enlarged  by  the  author,  for  his 
American  publishers,  and  it  seems  to  us  that  there  is 
scarcely  any  species  of  desirable  information  on  its 
subjects  that  may  not  be  found  in  this  work. — The 
Western  Journal  of  Medicine  and  Surgery. 

We  are  gratified  to  announce  a  new  and  revised 
edition  of  Dr.  Churchill's  valuable  work  on  the  dis- 
eases of  females  We  have  ever  regarded  it  as  one 
of  the  very  best  works  on  the  subjects  embraced 
within  its  scope,  in  the  English  language;  and  the 
present  edition,  enlarged  and  revised  by  the  author, 
renders  it  still  more  entitled  to  the  confidence  of  the 
profession.  The  valuable  notes  of  Prof.  Huston 
have  been  retained,  and  contribute,  in  no  small  de- 
gree, to  enhance  the  value  of  the  work.  It  ia  a 
source  of  congratulation  that  the  publishers  have 
permitted  the  author  to  be,  in  this  instance,  his 
own  editor,  thus  securing  all  the  revision  which 
an  author  alone  is  capable  of  making. — The  Western 
Lancet. 

Asa  comprehensive  manual  for  students,  or  a 
work  of  reference  for  practitioners,  we  only  speak 
with  common  justice  when  we  say  that  it  surpasses 
any  other  that  has  ever  issued  on  the  same  sub- 
ject from  the  British  press.— The  Dublin  Quarterly 
Journal. 


DEVVEES   (W.    P.),   M.D.,    &c. 

A  COMPKEHENSIVE  SYSTEM  OF  MIDWIFERY.  Illustrated  by  occa- 
sional Cases  and  many  Engravings.  Twelfth  edition,  with  the  Author's  last  Improvements  and 
Corrections.  In  one  octavo  volume,  of  600  pages.  (Just  Issued.) 

BY   THE   SAME   AUTHOR. 

A  TREATISE  ON  THE  PHYSICAL  AND  MEDICAL  TREATMENT  OF 

CHILDREN.     Tenth  edition.     In  one  volume,  octavo,  548  pages.     (Just  Issited.) 

BY   THE    SAME   AUTHOR. 

A  TREATISE  ON   THE   DISEASES   OF   FEMALES.     Tenth   edition.     In 

one  volume,  octavo,  532  pages,  with  plates.     (Just  Issued.) 


DICKSON   (PROFESSOR   S.    H.),    M.  D. 
ESSAYS  ON  LIFE,  SLEEP,  PAIN,  INTELLECTION,  HYGIENE,  AND 

DEATH.    In  one  very  handsome  volume,  royal  12mo. 



DANA   (JAMES    D). 

ZOOPHYTES  AND  CORALS.     In  one  volume,  imperial  quarto,  extra  cloth, 

with  wood-cuts. 

ALSO, 

AN  ATLAS  TO  THE  ABOVE,  one  volume,  imperial  folio,  with  sixty-one  mag- 
niiicent  plates,  colored  after  nature.    Bound  in  half  morocco. 

ALSO, 

ON    THE    STRUCTURE    AND    CLASSIFICATION    OF    ZOOPHYTES. 

Sold  separate,  one  vol.,  cloth. 


DE    LA    BECHE   (SIR    HENRY    T.),   F.  R.  S.,  Ac. 

THE  GEOLOGICAL  OBSERVER.     In  one  very  large,  and  handsome  octavo 
volume,  of  700  pages.    With  over  three  hundred  wood-cuts.     (Lately  Issued.) 


AND   SCIENTIFIC    PUBLICATIONS. 


11 


DRUITT   (ROBERT),   M.R.  C.S.,   &c. 
THE  PRINCIPLES  AND  PRACTICE  OF  MODERN  SURGERY.     A  new 

American,  from  the  improved  London  edition.  Edited  by  F.  W.  SARGENT,  M.  D.,  author  of 
"  Minor  Surgery,"  &c.  Illustrated  with  one  hundred  and  ninety-three  wood-engravings.  In 
one  very  handsomely  printed  octavo  volume,  of  576  large  pages. 


Dr.  Druitt's  researches  into  the  literature  of  his 
subject  have  been  not  only  extensive,  but  well  di- 
rected ;  the  most  discordant  authors  are  fairly  and 
impartially  quoted,  and,  while  due  credit  is  given 
to  each,  their  respective  merits  are  weighed  with 
an  unprejudiced  hand.  The  grain  of  wheat  is  pre- 
served, and  the  chaff  is  unmercifully  stripped  off. 
The  arrangement  is  simple  and  philosophical,  and 
the  style,  though  clear  and  interesting,  is  so  precise, 
that  the  book  contains  more  information  condensed 
into  a  few  words  than  any  other  surgical  work  with 
which  we  are  acquainted. — London  Medical  Times 
and  Gazette,  February  18,  1654. 

No  work,  in  our  opinion,  equals  it  in  presenting 
so  much  valuable  surgical  matter  in  so  small  a 
compass. — St.  Louis  Med.  and  Surgical  Journal. 

Druitt's  Surgery  is  too  well  known  to  the  Ameri- 
can medical  profession  to  require  its  announcement 
anywhere.  Probably  no  work  of  the  kind  has  ever 
been  more  cordially  received  and  extensively  circu- 
lated than  this  The  fact  that  it  comprehends  in  a 
comparatively  small  compass,  all  the  essential  ele- 
ments of  theoretical  and  practical  Surgery — that  it 
is  found  to  contain  reliable  and  authentic  informa- 
tion on  the  nature  and  treatment  of  nearly  all  surgi- 
cal affections — is  a  sufficient  reason  for  the  liberal 
patronage  it  has  obtained.  The  editor,  Dr.  F.  W. 
Sargent,  has  contributed  much  to  enhance  the  value 
of  the  work,  by  such  American  improvements  as  are 
calculated  more  perfectly  to  adapt  it  to  our  own 
views  and  practice  in  this  country.  It  abounds 
everywhere  with  spirited  and  life-like  illustrations, 
which  to  the  young  surgeon,  especially,  are  of  no 
minor  consideration.  Every  medical  man  frequently 
needs  just  such  a  work  as  this,  for  immediate  refe- 
rence in  moments  of  sudden  emergency,  when  he  has 
Dot  time  to  consult  more  elaborate  treatises. — The 
Ohio  Medical  and  Surgical  Journal. 

The  author  has  evidently  ransacked  every  stand- 
ard treatise  of  ancient  and  modern  times,  and  all  that 


is  really  practically  useful  at  the  bedside  will  be 
found  in  a  form  at  once  clear,  distinct,  imd  interest- 
ing.— Edinburgh  Monthly  Medical  Journal. 

Druitt's  work,  condensed,  systematic,  lucid,  and 
practical  as  it  is,  beyond  most  works  on  Surgery 
accessible  to  the  American  student,  has  had  much 
currency  in  this  country,  and  under  its  present  au- 
spices promises  to  rise  to  yet  higher  favor. — The 
Western  Journal  of  Medicine  and  Surgery. 

The  most  accurate  and  ample  resume  of  the  pre- 
sent state  of  Surgery  that  we  are  acquainted  with. — 
Dublin  Medical  Journal. 

A  better  book  on  the  principles  and  practice  of 
Surgery  as  now  understood  in  England  and  America, 
has  not  been  given  to  the  profession. — Boston  Medi- 
cal and  Surgical  Journal. 

An  unsurpassable  compendium,  not  only  of  Sur- 
gical, but  of  Medical  Practice. — London  Medical 
Gazette. 

This  work  merits  our  warmest  commendations, 
and  we  strongly  recommend  it  to  young  surgeons  as 
an  admirable  digest  of  the  principles  and  practice  of 
modern  Surgery. — Medical  Gazette. 

It  may  be  said  with  truth  that  the  work  of  Mr. 
Druitt  affords  a  complete,  though  brief  and  con- 
densed view,  of  the  entire  field  of  modern  surgery. 
We  know  of  no  work  on  the  same  subject  having  the 
appearance  of  a  manual,  which  includes  so  many 
topics  of  interest  to  the  surgeon  ;  and  the  terse  man- 
ner in  which  each  has  been  treated  evinces  a  most 
enviable  quality  of  mind  on  the  part  of  the  author, 
who  seems  to  have  an  innate  power  of  searching 
out  and  grasping  the  leading  facts  and  features  of 
the  most  elaborate  productions  of  the  pen.  It  is  a 
useful  handbook  for  the  practitioner,  and  we  should 
deem  a  teacher  of  surgery  unpardonable  who  did  not 
recommend  it  to  his  pupils.  In  our  own  opinion,  it 
is  admirably  adapted  to  the  wants  of  the  student. — 
Provincial  Medical  and  Surgical  Journal . 


DUNGLISON,    FORBES,   TWEEDIE,   AND   CONOLLY. 
THE  CYCLOPAEDIA  OF  PRACTICAL  MEDICINE:  comprising  Treatises  on 

the  Nature  and  Treatment  of  Diseases,  Materia  Medica,  and  Therapeutics,  Diseases  of  Women, 
and  Children,  Medical  Jurisprudence,  &c.  &c.  In  four  large  super  royal  octavo  volumes,  of 
3254  double-columned  pages,  strongly  and  handsomely  bound. 

*^*  This  work  contains  no  less  than  four  hundred  and  eighteen  distinct  treatises,  contributed  by 
sixty-eight  distinguished  physicians. 


The  most  complete  work  on  Practical  Medicine 
extant;  or,  at  least,  in  our  language.—  Buffalo 
Medical  and  Surgical  Journal. 

For  reference,  it  is  above  all  price  to  every  prac- 
titioner.— We  stern  Lancet. 

One  of  the  most  valuable  medical  publications  of 
the  day— as  a  work  of  reference  it  is  invaluable.— 
Western  Journal  of  Medicine  and  Surgery. 

It  has  been  to  us,  both  as  learner  and  teacher,  a 
work  for  ready  and  frequent  reference,  one  in  which 
modern  English  medicine  is  exhibited  in  the  most 
advantageous  light.— Medical  Examiner. 

We  rejoice  that  this  work  is  to  be  placed  within 
the  reach  of  the  profession  in  this  country,  it  being 


unquestionably  one  of  very  great  value  to  the  prac- 
titioner. This  estimate  of  it  has  not  been  formed 
from  a  hasty  examination,  but  after  an  intimate  ac- 
quaintance derived  from  frequent  consultation  of  it 
during  the  past  nine  or  ten  years.  The  editors  are 
practitioners  of  established  reputation,  and  the  list 
of  contributors  embraces  many  of  the  most  eminent 
professors  and  teachers  of  London,  Edinburgh,  Dub- 
lin, and  Glasgow.  It  is,  indeed,  the  great  merit  of 
this  work  that  the  principal  articles  have  been  fur- 
nished by  practitioners  who  have  not  only  devoted 
especial  attention  to  the  diseases  about  which  they 
have  written,  but  have  also  enjoyed  opportunities 
for  an  extensive  practical  acquaintance  with  them, 
and  whose  reputation  carries  the  assurance  of  their 
competency  justly  to  appreciate  the  opinions  of 
others,  while  it  stamps  their  own  doctrines  with 
high  and  just  authority.— American  Medical  Journ. 


DUNGLISON    (ROBLEY),    M.  D., 

Professor  of  the  Institutes  of  Medicine,  in  the  Jefferson  Medical  College,  Philadelphia. 

HUMAN  HEALTH;  or,  the  Influence  of  Atmosphere  and  Locality,  Change  of 

Air  and  Climate,  Seasons,  Food,  Clothing,  Bathing,  Exercise,  Sleep,  &c.  &c.,  on  Healthy  Man ; 
constituting  Elements  of  Hygiene.  Second  edition,  with  many  modifications  and  additions.  In 
one  octavo  volume,  of  464  pages. 


12 


BLANCHARD   &   LEA'S    MEDICAL 


DUNGLISON    (ROBLEY),    M.  D., 

Professor  of  Institutes  of  Medicine  in  the  Jefferson  Medical  College,  Philadelphia. 

MEDICAL  LEXICON;   a  Dictionary  of  Medical  Science,  containing  a  concise 

Explanation  of  the  various  Subjects  and  Terms  of  Physiology,  Pathology,  Hygiene,  Therapeutics, 
Pharmacology,  Obstetrics,  Medical  Jurisprudence,  &c.  With  the  French  and  other  Synonymes  ; 
Notices  of  Climate  and  of  celebrated  Mineral  Waters;  Formulae  for  various  Officinal,  "Empirical, 
and  Dietetic  Preparations,  etc.  Eleventh  edition,  revised.  In  one  very  thick  octavo  volume,  of 
over  nine  hundred  large  double-columned  pages,  strongly  bound  in  leather,  with  raised  band*. 
(Just  Issued.) 

Every  successive  edition  of  this  work  bears  the  marks  of  the  industry  of  the  author,  and  of  his 
determination  to  keep  it  fully  on  a  level  with  the  most  advanced  state  of  medical  science.  Thus 
nearly  FIFTEEN  THOUSAND  WORDS  have  been  added  to  it  within  the  last  few  years.  As  a  complete 
Medical  Dictionary,  therefore,  embracing  over  FIFTY  THOUSAND  DEFINITIONS,  in  all  the 
branches  of  the  science,  it  is  presented  as  meriting  a  continuance  of  the  great  favor  and  popularity 
which  have  carried  it,  within  no  very  long  space  of  time,  to  an  eleventh  edition. 

Every  precaution  has  been  taken  in  the  preparation  of  the  present  volume,  to  render  its  mecha- 
nical execution  and  typographical  accuracy  worthy  of  its  extended  reputation  and  universal  use. 
The  very  extensive  additions  have  been  accommodated,  without  materially  increasing  the  bulk  of 
the  volume  by  the  employment  of  a  small  but  exceedingly  clear  type,  cast  for  this  purpose.  The 
press  has  been  watched  with  great  care,  and  every  effort  used  to  insure  the  verbal  accuracy  so  ne- 
cessary to  a  work  of  this  nature.  The  whole  is  printed  on  fine  white  paper  ;  and,  while  thus  exhi- 
biting "in  every  respect  so  great  an  improvement  over  former  issues,  it  is  presented  at  the  original 
exceedingly  low  price. 

We  welcome  it  cordially;  it  is  an  admirable  work,  J  valuable  work,  we   directed  the  attention  of  our 
and  indispensable  to  all  literary  medical  men.    The  '  —°H «,,..,  t~    ;..    ^«.,»;Q,    m~,\*0.   „,„»,„.,   n~0A  A<* 
labor  which  has  been  bestowed  apon  it  is  something 
prodigious.      The  work,   however,  has  now  been 
done,  and  we  are  happy  in  the  thought  that  no  hu- 
man being  will  have  again  to  undertake  the  same 
gigantic  task.     Revised  and  corrected  from  time  to 
time,  Dr.  Dunglison's  (i  Medical  Lexicon"  will  last 
for  centuries.— British  and  Foreign  Med.  Chirurg. 
Review,  July,  1853. 

The  fact  that  this  excellent  and  learned  work  has 


passed  through  eight  editions,  and  that  a  ninth  is 
rendered  necessary  by  the  demands  of  the  public, 
affords  a  sufficient  evidence  of  the  general  apprecia- 
tion of  Dr.  Dunglison's  labors  by  the  medical  pro- 
fession in  England  and  America.  It  is  a  book  which 
will  be  of  great  service  to  the  student,  in  teaching 
him  the  meaning  of  all  the  technical  terms  used  in 
medicine,  and  will  be  of  no  less  use  to  the  practi- 
tioner who  desires  to  keep  himself  on  a  levd  with 
the  advance  of  medical  science. — London  Medical 
Times  and  Gazette. 

In  taking  leave  of  our  author,  we  feel  compelled 
to  confess  that  his  work  bears  evidence  of  almost 
incredible  labor  having  been  bestowed  upon  its  com- 
position.—  Edinburgh  Journal  of  Med.  Sciences. 
Sept.  1853. 

A  miracle  of  labor  and  industry  in  one  who  has 
written  able  and  voluminous  works  on  nearly  every 
branch  of  medical  science.  There  could  be  no  more 
useful  book  to  the  student  or  practitioner,  in  the 
present  advancing  age,  than  one  in  which  would  be 
found,  in  addition  to  the  ordinary  meaning  and  deri- 
vation of  medical  terms — so  many  of  which  are  of 
modern  introduction — concise  descriptions  of  their 
explanation  and  employment;  and  all  this  and  much 
more  is  contained  in  the  volume  before  us.  It  is 
therefore  almost  as  indispensable  to  the  other  learned 
professions  as  to  our  own.  In  fact,  to  all  who  may 
have  occasion  to  ascertain  the  meaning  of  any  word 
belonging  to  the  many  branches  of  medicine.  From 


readers  to  its  peculiar  merits;  and  we  need  do 
little  more  than  state,  in  reference  to  the  present 
reissue,  that,  notwithstanding  the  large  additions 
previously  made  to  it,  no  fewer  than  four  thou- 
sand terms,  not  to  be  found  in  the  preceding  edi- 
tion, are  contained  in  the  volume  before  us. — 
Whilst  it  is  a  wonderful  monument  of  its  author's 
erudition  and  industry,  it  is  also  a  work  of  great 
practical  utility,  as  we  can  testify  from  our  own 
experience;  for  we  keep  it  constantly  within  OUT 
reach,  and  make  very  frequent  reference  to  it, 
nearly  always  finding  in  it  the  information  we  seek. 
— British  and  Foreign  Med.-Chirurg.  Review. 

It  has  the  rare  merit  that  it  certainly  has  no  rival 
in  the  English  language  for  accuracy  and  extent 
of  references.  The  terms  generally  include  short 
physiological  and  pathological  descriptions,  so  that, 
as  the  author  justly  observes,  the  reader  does  not 
possess  in  this  work  a  mere  dictionary,  but  a  book, 
which,  while  it  instructs  him  in  medical  etymo- 
logy, furnishes  him  with  a  large  amount  of  useful 
information.  The  author's  labors  have  been  pro- 
perly appreciated  by  his  own  countrymen  ;  and  we 
can  only  confirm  their  judgment,  by  recommending 
this  most  useful  volume  to  the  notice  of  our  cisat- 
lantic readers.  No  medical  library  will  be  complete 
without  it.— London  Med.  Gazette. 

It  is  certainly  more  complete  and  comprehensive 
than  any  with  which  we  are  acquainted  in  the 
English  language.  Few,  in  fact,  could  be  fonnd 
belter  qualified  than  Dr.  Dunglison  for  the  produc- 
tion of  such  a  work.  Learned,  industrious,  per- 
severing, and  accurate,  he  brings  to  the  task  all 
the  peculiar  talents  necessary  for  its  successful 
performance;  while,  at  the  same  time,  his  fami- 
liarity with  the  writings  of  the  ancient  and  modern 
"  masters  of  our  art,"  renders  him  skilful  to  note 
the  exact  usage  of  the  several  terms  of  science, 
and  the  various  modifications  which  medical  term- 
inology has  undergone  with  the  change  of  theo- 
ries or  the  progress  of  improvement.  —  American 
Medical  Sciences. 


a  careful  examination  of  the  present  edition,  we  can  Tntir~nj  nftkf 
vouch  for  its  accuracy,  and  for  its  being  brought 
quite  up  to  the  date  of  publication  ;  the  author  states  ,  °"e  of  the  most  complete  and  copions  known  to 
in  his  preface  that  he  hasadded  to  it  about  four  thou-  the  cultivators  of  medical  science.— Boston  Med. 
sand  terms,  which  are  not  to  be  found  in  the  prece-  Journal. 

ding   one.- Dublin  Quarterly  Journal  of  Medical        The  most  comprehensive  and  best  English  Dic- 
tionary of  medical  terms  extant.— Buffalo  Medical 
On  the  appearance  of  the  last  edition  of   this  |  Journal. 

BY   THE   SAME   AUTHOR. 

THE  PRACTICE  OF  MEDICINE.     A  Treatise  on  Special  Pathology  and  The- 
rapeutics.   Third  Edition.    In  two  large  octavo  volumes,  of  fifteen  hundred  pages. 


Upon  every  topic  embraced  in  the  work  the  latest 
information  will  be  found  carefully  posted  up. — 
Medical  Examiner. 

The  student  of  medicine  will  find,  in  these  two 
elegant  volumes,  a  mine  of  facts,  a  gathering  of 
precepts  and  advice  from  the  world  of  experience, 
that  will  nerve  him  with  courage,  and  faithfully 
direct  him  in  his  efforts  to  relieve  the  physical  suf- 


ferings of  the  race. — .Boston  Medical  and  Surgical 
Journal. 

It  is  certainly  the  most  complete  treatise  of  which 
we  have  any  knowledge. —  Western  Journal  of  Medi- 
cine and  Surgery. 

One  of  the  most  elaborate  treatises  of  the  kind 
we  have. — Southern  Med.  and  Surg.  Journal. 


AND   SCIENTIFIC    PUBLICATIONS. 


13 


DUNGLISON    (ROBLEY),    M.D., 

Professor  of  Institutes  of  Medicine  in  the  Jefferson  Medical  College,  Philadelphia. 


HUMAN  PHYSIOLOGY.  Seventh  edition.  Thoroughly  revised  and  exten- 
sively modified  and  enlarged,  with  nearly  five  hundred  illustrations.  In  two  large  and  hand- 
somely printed  octavo  volumes,  containing  nearly  1450  pages. 

It  has  long  since  taken  rank  a»  one  of  the  medi-  I  Physiology  in  the  English   language,  and  is  highly 
cat  classics  of  our  language.     To  say  that  it  is  by  |  creditable  to  the  author  and  publishers. — Canadian 
Oir  the  best  text-book  of  physiology  ever  published     Medical  Journal. 
in  this  country,   is  but  echoing   the  general  testi- 
mony of  the  profession  .—N.  Y.  Journal  of  Medicine.  \      The   most  complete  and   satisfactory  system  of 

I  Physiology  in  the  English  language.— Amer.  Med. 
There  is  no  single  book  we  would  recommend  to  |  Journal. 
the  student  or  physician,  with  greater  confidence 

Chan  the  present,  because  in  it  will  be  found  a  mir-        The  best  work  of  the  kind   in  the  English  laa- 
rorof  almost  every  standard  physiological  work  of    guage.— Silliman's  Journal. 
the  day.     We  most  cordially  recommend  the  work 

to  every  member  of  the  profession,  and  no  student  i      The  most  full  and  complete  system  of  Physiology 
should  be  without  it.    It  is  the  completes!  work  on    in  our  language. — Western  Lancet. 

BY    THE   SAME    AUTHOR.      (Just  Issued.) 

GENERAL    THERAPEUTICS    AND    MATERIA  MEDIC  A;   adapted  for  a 

Medical  Text-book.     Fifth  edition,  much  improved.    With  one  hundred  and  eighty-seven  illus- 
trations.   In  two  large  and  handsomely  printed  octavo  vols.,  of  about  1100  pages. 
The  new  editions  of  the  United  States  Pharmacopeia  and  those  of  London  and  Dublin,  have  ren- 
dered necessary  a  thorough  revision  of  this  work.     In  accomplishing  this  the  author  has  spared  no 
pains  in  rendering  it  a  complete  exponent  of  all  that  is  new  and  reliable,  both  in  the  departments 
of  Therapeutics  and  Mtiteria  Medica.     The  book  has  thus  been  somewhat  enlarged,  and  a  like  im 
provemeat  will  be  found  in  every  department  of  its  mechanical  execution.    As  a  convenient  text- 
book for  the  student,  therefore,  containing  within  a  moderate  compass  a  satisfactory  resume  of  its 
important  subject,  it  is  again  presented  as  even  more  worthy  than  heretofore  of  the  very  great  favor 
which  it  has  received. 


In  this  work  of  Dr.  Dunglison,  we  recognize  the  ! 
game  untiring  industry  in  the  collection   and  em- 
bodying of  facts  on  the  several  subjects  of  which  he  : 
treats,  that  has  heretofore  distinguished  him,  and  J 
we  cheerfully  point  to  these  volumes,  as  two  of  the  1 
most  interesting  that  we  know  of.     In  noticing  the 
additions  to  this,  the  fourth  edition,  there  is  very 
Little  ia  the  periodical  or  annual   literature  of  the  I 
profession,   published    in   the    interval   which    has  j 
elapsed  since  the  issue  of  the  first,  that  has  escaped  i 
the  careful  search  of  the  author.     As  a   book  for 
reference,  it  is  invaluable. — Charleston  Med.  Jour- 
nal and  Review. 


As  a  text-book  for  students,  for  whom  it  is  par- 
ticularly designed,  we  know  of  none  superior  to 
it. — St.  Louis  Medical  and  Surgical  Journal. 

It  purports  to  be  a  new  edition,  but  it  is  rather 
a  new  book,  so  greatly  has  it  been  improved,  both, 
in  the  amount  and  quality  of  the  matter  which  it 
contains. — N.  O.  Medical  and  Surgical  Journal. 

We  bespeak  for  this  edition,  from  the  profession, 
an  increase  of  patronage  over  any  of  its  former 
ones,  on  account  of  its  increased  merit.  —  N.  1". 
Journal  of  Medicine. 


It  may  be  said  to  be  the  work  now  upon  the  sub-        We  consider  this  work  unequalled.— Boston  Med. 
jects  upon  which  it  treats. —  Western  Lancet.  '  and  Surg.  Journal. 

BY   THE   SAME    AUTHOR. 

NEW  REMEDIES,  WITH  FORMULAE  FOR  THEIR  ADMINISTRATION. 

Sixth  edition,  with  extensive  Additions.     In  one  very  large  octavo  volume,  of  over  750  pages. 
One  of  the  most  useful  of  the  author's  works. —    diseases  and  for  remedies,  will  be  found  greatly  to 
Southern  Medical  and  Surgical  Journal.  enhance  its  value. — New  York  Med.  Gazette. 

This  well-known  and  standard  book  has  now 
reached  its  sixth  edition,  and  has  been*enlarged  and 
improved  by  tlie  introduction  of  all  the  recent  gifts 
to  therapeutics  which  the  last  few  years  have  so 
richly  produced,  including  the  anaesthetic  agents, 
&c.  This  elaborate  and  useful  volume  should  be 
found  in  every  medical  library,  for  as  a  book  of  re- 
ference, for  physicians,  it  is  unsurpassed  by  any 
other  work  ia  existence,  and  the  double  index  for 


The  great  learning  of  the  author,  and  his  remark- 
able industry  in  pushing  his  researches  into  every 
source  whence  information  is  derivable,  has  enabled 
him  to  throw  together  an  extensive  mass  of  facts 
and  statements,  accompanied  by  full  reference  to 
authorities;  which  last  feature  renders  the  work 
practically  valuable  to  investigators  who  desire  to 
examine  the  original  papers. — The  American  Journal 
of  Pharmacy. 


DURLACHER   (LEWIS). 
A   TREATISE   ON   CORNS,   BUNIONS,   THE    DISEASES    OF    NAILS, 

AND  THE  GENERAL  MANAGEMENT  OF   THE  FEET.    IH  one  12mo.  volume,  cloth. 
pp.  134. 


DE  JONGH  (L.  J.),  M.  D.,  &c. 
THE  THREE  KINDS   OF  COD-LIVER  OIL,  comparatively  considered,  with 

their  Chemical  and  Therapeutic  Properties.  Translated,  with  an  Appendix  and  Cases,  by 
EDWARD  CARRY,  M  D.  To  which  is  added  an  article  on  the  subject  from  "  Dunglison  on  New 
Remedies."  In  oue  small  12mo.  volume,  extra  cloth. 


DAY  (GEORGE  E.),  M.  D. 
A  PRACTICAL  TREATISE  ON  THE  DOMESTIC  MANAGEMENT  AND 

MORE  IMPORTANT  DISEASES  OF  ADVANCED  LIFE.  With  an  Appendix  on  a  new 
and  successful  mode  ot  treating  Lumbago  and  other  forms  of  Chronic  Rheumatism.  One  volume 
octavo,  226  pages. 


14 


BLANCHARD   &   LEA'S   MEDICAL 


ELLIS  (BENJAMIN),  M.D. 
THE   MEDICAL   FORMULARY :   being  a  Collection  of  Prescriptions,  derived 

from  the  writings  and  practice  of  many  of  the  most  eminent  physicians  of  America  and  Europe. 
Together  with  the  usual  Dietetic  Preparations  and  Antidotes  for  Poisons.  To  which  is  added 
an  Appendix,  on  the  Endermic  use  of  Medicines,  and  on  the  use  of  Elher  and  Chloroform.  The 
whole  accompanied  with  a  few  brief  Pharmaceutic  and  Medical  Observations.  Tenth  edition, 
revised  and  much  extended  by  ROBERT  P.  THOMAS,  M.  D.,  Professor  of  Materia  Medica  in  the 
Philadelphia  College  of  Pharmacy.  In  one  neat  octavo  volume,  of  two  hundred  and  ninety-six 
pages.  (Now  Ready,  Revised  and  enlarged  to  1854.) 

This  work  has  received  a  very  complete  revision  at  the.  hands  of  the  editor,  who  has  made  what- 
ever alterations  and  additions  the  progress  of  medical  and  pharmaceutical  science  has  rendered  ad- 
visable, introducing  fully  the  new  remedial  agents,  and  revising  the  whole  by  the  latest  improvements 
of  the  Pharmacopoeia.  To  accommodate  these  additions,  the  size  of  the  page  has  been  increased, 
and  the  volume  itself  considerably  enlarged,  while  every  effort  has  been  made  to  secure  the  typo- 
graphical accuracy  which  has  so  long  merited  the  confidence  of  the  profession. 


After  an  examination  of  the  new  matter  and  the 
alterations,  we  believe  the  reputation  of  the  work 
built  up  by  the  author,  and  the  late  distinguished 
editor,  will  continue  to  fl onrisli  under  the  anspiees 
of  the  present  editor,  who  has  the  industry  and  accu- 
racy, and,  we  would  say,  conscientiousness  requi- 
site for  the  responsible  task. — American  Journal  of 
Pharmacy,  March,  1S»4. 


It  will  prove  particularly  useful  to  students  nnd 
young  practitioners,  as  the  most  important  prescrip- 
tions employed  in  modern  practice,  which  lie  scat- 
tered through  our  medical  literature,  are  here  col- 
lected and  conveniently  arranged  for  reference. — 
Charleston  Med.  Journal  and  Review. 


ERICHSEN   (JOHN)., 

Professor  of  Surgery  in  University  College,  London,  &c. 

THE  SCIENCE  AND  ART  OF  SURGERY;  BEING  A  TREATISE  ON  SURGICAL 

INJURIES,  DISEASES,  AND  OPERATIONS.     With  Notes  and  Additions  by  the  American  Editor.     Il- 
lustrated with  over  three  hundred  engravings  on  wood.     In  one  large  and  handsome  octaro 
volume,  of  nearly  nine  hundred  closely  printed  pages.     (Now  Ready.) 
This  is  a  new  work,  brought  up  to  May,  1854. 

This  work,  which  is  designed  as  a  lext-book  for  the  student  and  practitioner,  will  be  found  a  very 
complete  treatise  on  the  principles  and  practice  of  surgery.  Embracing  both  these  branches  of  the 
subject  simultaneously,  and  elucidating  the  one  by  the  other,  it  enables  the  reader  to  take  a  compre- 
hensive view  of  the  objects  of  his  study,  and  presents  the  subjects  discussed  in  a  clear  and  con- 
nected manner.  The  author's  style  will  be  found  easy  and  flowing,  and  the  illustrations  having 
been  drawn  under  his  especial  supervision,  are  with  few  exceptions  new,  and  admirably  adapted 
to  elucidate  the  text  to  which  they  refer.  In  every  point  of  mechanical  execution,  it  will  be  one  of 
the  handsomest  works  issued  from  the  American  press. 

which  he  is  Professor,  and  we  can  eordinHy  recom- 
mend it  as  a  work  of  reference,  both  to  students  and 
practitioners. — Medical  Times  and  Gazette. 


The  aim  of  Mr.  Erichsen  appears  to  be  to  improve 
«pon  the  plan  of  Samuel  Cooper;  and  by  connecting 
in  one  volume  the  science  and  art  of  Surgery,  to 
supply  the  student  with  a  text-book  and  the  practi- 
tioner with  a  work  of  reference,  in  which  scientific 
principles  and  practic.il  details  are  alike  included. 
\Ve  may  say,  after  a  careful  pernsal  of  some  of 
the  chapters,  and  a  more  hasty  examination  of  the 
remainder,  that  it  must  raise  the  character  of  the 
author,  and  reflect  great  credit  upon  the  College  to 


"  We  do  not  hesitate  to  say  that  the  volume  before 
us  gives  a  very  admirable  practical  view  of  the  sci- 
ence and  art  of  surgery  of  the  present  day,  and  we 
have  no  doubt  that  it  will  be  highly  valued  as  a  sur- 
gical guide  as  well  by  the  surgeon  as  by  the  student 
of  surgery. — Edinburgh  Med.  and  Svrg.  Journal. 


FERGUSSON  (WILLIAM),  F.  R.  S., 

Professor  of  Surgery  in  King's   College,  London,  Sec. 

A  SYSTEM  OF  PRACTICAL  SURGERY.     Fourth  American,  from  the  third 

and  enlarged  London  edition.    In  one  large  and  beautifully  printed  octavo  volume,  of  about  seven 
hundred  pages,  with  three  hundred  and  ninety-three  handsome  illustrations.     (Just  Issued.) 

sively  on  operative  surgery  j  but  this  defect  is  now 
removed,  and  the  book  is  more  than  ever  adapted  for 


The  most  important  subjects  in  connection  with 
practical   surg&ry  which  have  been  more  recently 


brought  under  the  notice  of,  and  discussed  by,  the 
surgeons  of  Great  Britain,  are  fully  and  dispassion- 
ately considered  by  Mr.  Fergusson,  and  that  which 
was  before  wanting  has  now  been  supplied,  so  that 
we  can  now  look  upon  it  as  a  work  on  practical  sur- 
gery instead  of  one  on  operative  surgery  alone.  And 
we  think  the  author  has  shown  a  wise  discretion  in 
making  the  additions  on  surgical  disease  which  are 
to  be  found  in  the  present  volume,  and  has  very 
much  enhanced  its  value ;  for,  besides  two  elaborate 
chapters  on  the  diseases  of  bones  and  jointSj  which 
were  wanting  before,  he  has  headed  each  chief  sec- 
tion of  the  work  by  a  general  description  of  the  sur- 
gical disease  and  injury  of  that  region  of  the  body 
which  is  treated  of  in  each,  prior  to  entering  into  the 
consideration  of  the  more  special  morbid  conditions 
and  their  treatment.  There  is  also,  as  in  former 
editions,  a  sketch  of  the  anatomy  of  particular  re- 
gions. There  was  some  ground  formerly  for  the 
complaint  before  alluded  to,  that  it  dwelt  too  exclu- 


the  purposes  of  the  practitioner,  whether  he  confine* 
himself  more  strictly  to  the  operative  department, 
or  follows  surgery  on  a  more  comprehensive  scale. — 
Medical  Times  and  Gazette. 

No  work  was  ever  written  which  more  nearly 
comprehended  the  necessities  of   the  student  and 
practitioner,  and  was  more   carefully  arranged   to 
1  '  ,._flr.  Y.  Med.  and  Svrg. 


that  single  purpose  than  this 
Jovrnal. 


The  addition  of  many  new  pages  makes  this  work 
more  than  ever  indispensable  to  the  student  and  prac- 
titioner.— Ranking's  Abstract. 

Among  the  numerous  works  upon  surgery  pub- 
lished of  late  years,  we  know  of  none  we  value 
more  highly  than  the  one  before  us.  It  is  perhaps 
the  very  best  we  have  for  a  text-book  and  for  ordi- 
nary reference,  being  concise  and  eminently  practi- 
cal.— Southtrn  Med.  and  Kvrg.  Jovrnal. 


FRICK  (CHARLES),  M.  D. 

RENAL    AFFECTIONS;    their   Diagnosis  and  Pathology. 
One  volume,  royal  12mo.5  extra  cloth. 


With  illustrations. 


AND   SCIENTIFIC    PUBLICATIONS. 


FOWNES  (GEORGE),  PH.  D.,  &c. 
ELEMENTARY    CHEMISTRY;    Theoretical  and  Practical.     With  numerous 

illustrations.  A  new  American,  from  the  last  and  revised  London  edition.  Edited,  with  Addi- 
tions, by  ROBERT  BRIDGES,  M.  D.  In  one  large  royal  12mo.  volume,  of  over  550  pages,  with  181 
wood-cuts,  sheep,  or  extra  cloth.  (Now  Ready.) 

The  lamented  death  of  the  author  has  caused  the  revision  of  this  edition  to  pass  into  the  hands  of 
loose  distinguished  chemists,  H.  Bence  Jones  and  A.  W.  Hofmann,  who  have  fully  sustained  its 
reputation  by  the  additions  which  they  have  made,  more  especially  in  the  portion  devoted  to  Organic 
Chemistry,  considerably  increasing  the  size  of  the  volume.  This  labor  has  been  so  thoroughly 
performed,  that  the  American  Editor  has  found  but  little  to  add,  his  notes  consisting  chiefly  of  such 
matters  as  the  rapid  advance  of  the  science  has  rendered  necessary,  or  of  investigations  which  had 
apparently  been  overlooked  by  the  author's  friends. 

The  volume  is  therefore  again  presented  as  an  exponent  of  the  most  advanced  state  of  chemical 
science,  and  as  not  unworthy  a  continuation  of  the  marked  favor  which  it  has  received  as  an  ele- 
mentary text-book. 


We  know  of  no  better  text-book,  especially  in  the 
difficult  department  of  organic  chemistry,  upon 
which  it  is  particularly  full  and  satisfactory.  We 
would  recommend  it  to  preceptors  as  a  capital 
u  office  book"  for  their  students  who  are  beginners 
in  Chemistry.  It  is  copiously  illustrated  with  ex- 
cellent wood-cuts,  and  altogether  admirably  "  got 
ap."— N.  J.  Medical  Reporter,  March,  1654. 

A  standard  manual,  which  has  long  enjoyed  the 
reputation  of  embodying  much  knowledere  in  a  small 
space.  The  author  lias  achieved  the  difficult  task  of 
condensation  with  masterly  tact.  His  book  is  con- 
eise  without  being  dry,  and  brief  without  being  too 
dogmatical  or  general. — Virginia  Med.and  Surgical 
Journal. 


The  work  of  Dr.  Fownes  has  long  been  before 
the  public,  and  its  merits  have  been  fully  appreci- 
ated as  the  best  text-book  on  chemistry  now  in 
existence.  We  do  not,  of  course,  place  it  in  a  rank 
superior  to  the  works  of  Brande,  Graham,  Turner, 
Gregory,  or  Gmelin,  but  we  say  that,  as  a  work 
for  students,  it  is  preferable  to  any  of  them.— Lon- 
don Journal  of  Medicine. 

A  work  well  adapted  to  the  wants  of  the  student. 
It  is  an  excellent  exposition  of  the  chief  doctrines 
and  facts  of  modern  chemistry.  The  size  of  the  work. 
and  still  more  the  condensed  yet  perspicuous  style 
in  which  it  is  written,  absolve  it  from  the  charges 
very  properly  urged  against  most  manuals  termed 
popular.— Edinburgh  Monthly  Journal  of  Meiical 
Science. 


GRAHAM  (THOMAS),  F.  R.  S., 
Professor  of  Chemistry  in  University  College,  London,  Ice. 

THE  ELEMENTS  OF  CHEMISTRY.     Including  the  application  of  the  Science 

to  the  Arts.    With  numerous  illustrations.    With  Notes  and  Additions,  by  ROBERT  BRIDGES, 
M.  D.,  &c.  fee.     Second  American,  from  the  second  and  enlarged  London  edition 
PART  I.  (Lately  Issued)  large  8vo.,  430  pages,  185  illustrations. 
PART  II.  (Preparing)  to  match. 

The  great  changes  which  the  science  of  chemistry  has  undergone  within  the  l$st  few  years,  ren- 
der a  new  edition  of  a  treatise  like  the  present,  almost  a  new  work.  The  author  has  devoted 
several  years  to  the  revision  of  his  treatise,  and  has  endeavored  to  embody  in  it  every  fact  and 
inference  of  importance  which  has  been  observed  and  recorded  by  the  great  body  of  chemical 
investigators  who  are  so  rapidly  changing  the  face  of  the  science.  In  this  manner  the  work  has 
been  greatly  increased  in  size,  and  the  number  of  illustrations  doubled ;  while  the  labors  of  the  editor 
have  been  directed  towards  the  introduction  of  such  matters  as  have  escaped  the  attention  of  the 
author,  or  as  have  arisen  since  the  publication  of  the  first  portion  of  this  edition  in  London,  in  1850. 
Printed  in  handsome  style,  and  at  a  very  low  price,  it  is  therefore  confidently  presented  to  the  pro- 
fession and  the  student  as  a  very  complete  and  thorough  text-book  of  this  important  subject. 

GROSS  (SAMUEL  D.),   M.  D., 
Professor  of  Surgery  in  the  Louisville  Medical  Institute,  Sec. 

A  PRACTICAL  TREATISE  ON  THE  DISEASES   AND  INJURIES   OF 

THE  URINARY  ORGANS.    In  one  large  and  beautifully  printed  octavo  volume,  of  over  seven 
hundred  pages.    With  numerous  illustrations. 


A  volume  replete  with  truths  and  principles  of  the 
utmost  value  in  the  investigation  of  these  diseases.— 
American  Medical  Journal. 

Dr.  Gross  has  brought  all  his  learning,  experi- 
ence, tact,  and  judgment  to  the  task,  and  has  pro- 
duced a  work  worthy  of  his  high  reputation.  We 
feel  perfectly  safe  in  recommending  it  to  our  read- 
ers as  a  monograph  unequalled  in  interest  and 
practical  value  by  any  other  on  the  subject  in  our 
language. — Western  Journal  of  Med.  and  Snrg. 

It  has  remained  for  an  American  writer  to  wipe 


this  department  of  art.  We  have,  indeed,  unfeigned 
pleasure  in  congratulating  all  concerned  in  this  pub- 
lication, on  the  result  of  their  labours;  and  expe- 
rience a  feeling  something  like  what  animates  a  long- 
expectant  husbandman,  who,  oftentimes  disappointed 
by  the  produce  of  a  favorite  field,  is  at  last  agree- 
ably surprised  by  a  stately  crop  which  may  bear 
comparison  with  any  of  its  former  rivals.  The 
grounds  of  our  high  appreciation  of  the  work  will 
be  obvious  as  we  proceed;  and  we  doubt  not  that. 
the  present  facilities  for  obtaining  American  books 
will  induce  many  of  our  readers  to  verify  our  re- 


Britisk 


away  this  reproach  ;  and  so  completely  has  the  task  commendation  by  their  own  perusal  of  it.— 
been  fulfilled,  that  we  venture  to  .predict  for  Dr.  \  and  Forei gn  Medico-Chirurgical  Review. 
Gross's  treatise  a  permanent  place  in  the  literature 
of  surgery,  worthy  to  rank  with  the  best  works  of  Whoever  will  peruse  the  vast  amount  of  valuable 
the  present  age.  Not  merely  is  the  matter  good,  practical  information  it  contains,  and  which  we 
but  the  getting  up  of  the  volume  is  most  creditable  have  been  un.-ible  even  to  notice,  will,  we  think, 
to  transatlantic  enterprise;  the  paper  and  print  agree  with  us,  that  there  is  no  work  in  the  English 
would  do  credit  toa  first-rate  London  establishment ;  language  which  can  make  any  just  pretensions  to 
and  the  numerous  wood-cuts  which  illustrate  it,  de-  be  its  equal. — N.  Y.  Journal  of  Medicine. 
monstrate  that  America  is  making  rapid  advances  in  i 

BY  THE  SAME  AUTHOR.      (In  Press.) 

A  PRACTICAL  TREATISE  ON  FOREIGN  BODIES  IN  THE  AIR-PAS- 

SAGES.     In  one  handsome  octavo  volume,  with  illustrations. 

BY  THE  SAME  AUTHOR.     (Preparing.) 

A  SYSTEM  OF  SURGERY;  Diagnostic,  Pathological,  Therapeutic,  and  Opera- 


16 


BLANCHARD    &    LEA'S    MEDICAL 


GLUGE  (GOTTLIEB),  M.  D., 

Professor  of  Physiology  and  Pathological  Anatomy  in  the  University  of  Brussels,  &e. 

AN  ATLAS   OF   PATHOLOGICAL   HISTOLOGY.     Translated,  with  Notes 

and  Additions,  by  JOSEPH  LEIDY,  M.  D.,  Professor  of  Anatomy  in  the  University  of  Pennsylva- 
nia. In  one  volume,  very  large  imperial  quarto,  with  three  hundred  and  twenty  figures,  plain 
and  colored,  on  twelve  copperplates. 

This  being,  as  far  as  we  know,  the  only  work  in  I  the  unconnected  observations  of  a  great  namber  of 
which  pathological  histology  is  separately  treated  J  authors.  The  development  of  the  morbid  tissues, 
of  in  a  comprehensive  manner,  it  will,  we  think,  for  |  and  the  formation  of  abnormal  products,  may  now 
this  reason,  be  of  infinite  service  to  those  who  desire  be  followed  and  studied  with  the  same  ease  and 
to  investigate  the  subject  systematically,  and  who  I  satisfaction  as  the  best  arranged  system  of  phy- 
bave  felt  the  difficulty  of  arranging  in  their  mind  |  siology. — American  Med.  Journal. 


GRIFFITH  (ROBERT  E.),  M.  D.,  &c. 

A  UNIVERSAL  FORMULARY,  containing  the  methods  of  Preparing  and  Ad- 
ministering Officinal  and  other  Medicines.  The  whole  adapted  to  Physicians  and  Pharmaceu- 
tists. SECOND  EDITION,  thoroughly  revised,  with  numerous  additions',  by  ROBERT  P.  THOMAS, 
M.  D.,  Professor  of  Materia  Mediea  in  the  Philadelphia  College  of  Pharmacy.  In  one  large  and 
handsome  octavo  volume,  of  over  six  hundred  pages,  double  columns.  (Just  Ready.) 

The  speedy  exhaustion  of  a  large  edition,  and  the  demand  for  a  second,  sufficiently  show  the  posi- 
tion which  this  work  has  so  rapidly  attained  as  an  authoritative  and  convenient  work  of  reference  for 
the  physician  and  pharmaceutist.  The  opportunity  thus  afforded  for  its  improvement  has  not  been 
neglected.  In  its  revision,  Professor  Thomas  (to  whom  this  task  has  been  confided  in  consequence 
of  the  death  of  the  author),  has  spared  no  labor,  in  the  hope  of  rendering  it  the  most  complete  and 
correct  work  on  the  subject  as  yet  presented  to  the  profession  AH  the  newly  introduced  articles 
of  the  Materia  Mediea  have  been  inserted,  such  formulse  as  had  escaped  the  attention  of  the  author 
have  been  added,  and  the  whole  has  been  most  carefully  read  and  examined,  to  insure  the  absolute 
oorrectness,  so  indispensable  in  a  work  of  this  nature.  The  amount  of  these  additions  may  be  esti- 
mated from  the  fact  that  not  only  has  the  page  been  considerably  enlarged,  but  the  volume  has  also 
been  increased  by  about  fifty  pages,  while  the  arrangement  of  the  formulse  and  the  general  typo- 
graphical execution  will  be  found  to  have  undergone  great  improvement.  To  the  practitioner,  its 
copious  collection  of  all  the  forms  and  combinations  of  the  articles  of  the  Pharmacopoeia  render  it 
an  invaluable  book  of  reference,  while  its  very  complete  embodiment  of  officinal  preparations  of  aM 
kinds,  derived  from  all  sources,  American,  English,  and  Continental,  make  it  an  indispensable  assist- 
lant  to  the  apothecary. 


Dr.  Griffith's  Formulary  is  worthy  of  recommen- 
dation, not  only  on  account  of  the  care  which  has 
been  bestowed  on  it  by  its  estimable  author,  but  for 
its  general  accuracy,  and  the  richness  of  its  details. 
— Medical  Examiner. 

Most  cordially  we  recommend  this  Universal 
Formulary,  not  forgetting  its  adaptation  to  drug- 
gists and  apothecaries,  who  would  find  themselves 
A'astly  improved  by  a  familiar  acquaintance  with 
this  every-day  book  of  medicine. — The  Boston  Med. 
and  Surg.  Journal. 


Pre-eminent  among  the  best  and  most  useful  com- 
pilations of  the  present  day  will  be  found  the  work 
before  us,  which  can  have  been  produced  only  at  a 
very  great  cost  of  thought  and  labor.  A  short  de- 
scription will  suffice  to  show  that  we  do  not  put 
too  high  an  estimate  on  this  work.  We  are  not  cog- 
nizant of  the  existence  of  a  parallel  work.  Its  value 
will  be  apparent  to  our  readers  from  the  sketch  of 
its  contents  above  given.  We  strongly  recommend 
it  to  all  \vho  are  engaged  either  in  practical  medi- 
cine, or  more  exclusively  with  its  literature.— Lond. 
Med.  Gazette. 


A  valuable  acquisition  to  the  medical  practitioner, 
and  a  usefal  book  of  reference  to  the  apothecary  OB 
numerous  occasions. — Amer.  Journal  of  Pharmacy. 


A  very  useful  work,  and  a  most  complete  compen- 
dium on  the  subject  of  materia  medica.  We  know 
of  no  work  in  our  langruige,  or  any  other,  so  com- 
prehensive in  all  its  details. — London  Lancet. 

• 
BY   THE  SAME   AUTHOR. 

MEDICAL  BOTANY;  or,  a  Description  of  all  the  more  important  Plants  used 
in  Medicine,  and  of  their  Properties,  Uses,  and  Modes  of  Administration.  In  one  large  octavo 
volume,  of  704  pages,  handsomely  printed,  with  nearly  350  illustrations  on  wood. 

One  of  the  few  hooks  which  supply  a  positive  de- 
ive. — Western  Lancet. 


One  of  the  greatest  acquisitions  to  American  medi- 
cal literature.  It  should  by  all  means  be  introduced, 
at  the  very  earliest  period,  into  our  medical  schools, 
and  occupy  a  place  in  the  library  of  every  physician 
in  the  land. — South-western  Medical  Advocate. 

Admirably  calculated  for  the  physician  and  stu- 
dent —  we  have  seen  no  work  which  promises 
greater  advantages  to  the  profession. — N.  O.  Med. 
and  Surg.  Journal. 


ficiency  in  our  medical  literature. 

We  hope  the  day  is  not  distant  when  this  work 
will  not  only  be  a  text-book  in  every  medical  school 
and  college  in  the  Union,  but  find  a  place  in  the  li- 
brary of  every  private  practitioner. — N.  Y.  Journal 
of  Medicine. 


GREGORY  (WILLIAM),   F.  R.  S.  E., 

Professor  of  Chemistry  in  the  University  of  Edinburgh,  Ac. 

LETTERS    TO  A  CANDID    INQUIRER    ON    ANIMAL 

Description  and  Analysis  of  the  Phenomena.     Details  of  Facts  and  Cases, 
royal  12mo.,  extra  cloth. 


MAGNETISM. 

In  one  neat  volume, 


GARDNER  (D.  PEREIRA),  M.  D. 

MEDICAL  CHEMISTRY,  for  the  use  of  Students  and  the  Profession :  being  a 
Manual  of  the  Science,  with  its  Applications  to  Toxicology,  Physiology,  Therapeutics,  Hygiene, 
&c.  In  one  handsome  royal  12mo.  volume,  with  ill  ustra' ions. 

ban 


AND    SCIENTIFIC    PUBLICATIONS.  17 

HASSE  (C.  E.),   M.  D. 

AN  ANATOMICAL  DESCRIPTION  OF  THE  DISEASES  OF  RESPIRA- 
TION AND  CIRCULATION.     Translated  and  Edited  by  SWAINE.    In  one  volume,  octavo. 

HARRISON  (JOHN),   M.D. 
AN   ESSAY  TOWARDS  A  CORRECT  THEORY  OF  THE  NERVOUS 

SYSTEM.    In  one  octavo  volume,  292  pages. 

HUNTER  (JOHN). 
TREATISE  ON  THE  VENEREAL  DISEASE.     With  copious  Additions,  by 

DR.  PH.  RICOED,  Surgeon  to  the  Venereal  Hospital  of  Paris.     Edited,  with  additional  Notes,  by 
F.  J.  BUMSTEAD,  M.  D.     In  one  octavo  volume,  with  plates     (Now  Ready.)    ^^  See  RICORD. 
ALSO,  HUNTER'S  COMPLETE  WORKS,  with  Memoir,  Notes,  &c.  &c.    In  four  neat  octavo 
volumes,  with  plates. 

HUGHES   (H.    M.),  M.  D., 

Assistant  Physician  to  Guy's  Hospital,  &c. 

A  CLINICAL  INTRODUCTION   TO   THE    PRACTICE   OF  AUSCULTA- 

TION,  and  other  Modes  of  Physical  Diagnosis,  in  Diseases  of  the  Lungs  and  Heart.     Second 
American  from  the  Second  and  Improved  London  Edition.  In  one  royal  12mo.  vol.  (Just  Ready.) 
It  has  been  carefully  revised  throughout.     Some  small  portions  have  been  erased ;  much  has 
been,  I  trust,  amended;  and  a  great  deal  of  new  matter  has  been  added;  so  that,  though  funda- 
mentally it  is  the  same  book,  it  is  in  many  respects  a  new  work. — Preface. 


HORNER  (WILLIAM  E.),  M.  D., 
Professor  of  Anatomy  in  the  University  of  Pennsylvania. 

SPECIAL   ANATOMY   AND    HISTOLOGY.     Eighth  edition.     Extensively 

revised  and  modified.     In  two  large  octavo  volumes,  of  more  than  one  thousand  pages,  hand- 
somely printed,  with  over  three  hundred  illustrations. 

This  work  has  enjoyed  a  thorough  and  laborious  revision  on  the  part  of  the  author,  with  the 
view  of  bringing  it  fully  up  to  the  existing  state  of  knowledge  on  the  subject  of  general  and  special 
anatomy.  To  adapt  it  more  perfectly  to  the  wants  of  the  student,  he  has  introduced  a  large  number 
of  additional  wood-engravings,  illustrative  of  the  objects  described,  while  the  publishers  have  en- 
deavored to  render  the  mechanical  execution  of  the  work  worthy  of  the  extended  reputation  which 
it  has  acquired.  The  demand  which  has  carried  it  to  an  EIGHTH  EDITION  is  a  sufficient  evi- 
dence of  the  value  of  the  work,  and  of  its  adaptation  to  the  wants  of  the  student  and  professional 
reader. 

HOBLYN  (RICHARD  D.),  A.  M. 
A  DICTIONARY  OF  THE   TERMS   USED  IN  MEDICINE   AND   THE 

COLLATERAL   SCIENCES.     Second  and  Improved  American  Edition.     Revised,  with  nu- 
merous Additions,  from  the  second  London  edition,  by  ISAAC  HAYS,  M.  D.,  &c.     In  one  large 
royal  12mo.  volume,  of  over  four  hundred  pages,  double  columns.     (Nearly  Ready.) 
In  passing  this  work  a  second  time  through  the  press,  the  editor  has  subjected  it  to  a  very  tho- 
rough revision,  making  such  additions  as  the  progress  of  science  has  rendered  desirable,  and  sup- 
plying any  omissions  that  may  have  previously  existed.     As  a  concise  and  convenient  Dictionary 
of  Medical  Terms,  at  an  exceedingly  low  price,  it  will  therefore  be  found  of  great  value  to  the  stu- 
dent and  practitioner.  

HOPE  (J.),  M.  D.,  F.  R.  S.,  &c. 
A  TREATISE  ON  THE   DISEASES    OF   THE    HEART    AND   GREAT 

VESSELS.    Edited  by  PENNOCK.     In  one  volume,  octavo,  with  plates,  572  pages. 

HERSCHEL  (SIR  JOHN    F.  W.),  F.  R.  S.,  &c. 
OUTLINES  OF  ASTRONOMY.     New  American,  from  the  third  London  edition. 

In  one  neat  volume,  crown  octavo,  with  six  plates  and  numerous  wood-cuts.     (Just  Issued.) 

HUMBOLDT  (ALEXANDER). 
ASPECTS  OF   NATURE    IN   DIFFERENT   LANDS    AND  DIFFERENT 

CLIMATES.    Second  American  edition,  one  vol.  royal  12mo.,  extra  cloth. 


JONES  (T.  WHARTON),   F.  R.  S.,  &c. 
THE  PRINCIPLES  AND  PRACTICE  OF   OPHTHALMIC    MEDICINE 

AND  SURGERY.    Edited  by  ISAAC  HAYS,  M.  D.,  &c.     In  one  very  neat  volume,  large  royal 
12mo.,  of  529  pages,  with  four  plates,  plain  or  colored,  and  ninety-eight  wood-cuts. 
The  work  amply  sustains,  in  every  point  the  al-     might  become,   a  manual  for  daily  reference  and 
ready  high  reputation  of  the  author  as  an  ophthalmic     consultation  by  the  student  and  the  general  practi- 
surgeon  as  well  as  a  physiologist  and  pathologist,     tioner.     The  work  is  marked  by  that  correctness. 
The  book  is  evidently  the  result  of  much  labor  and     clearness,  and  precision  of  style  which  distinguish 
research,  and  has  been  written  with   the  greatest    all  the  productions  of  the  learned  author.— British 
care  and  attention.    We  entertain  little  doubt  that    and  Foreign  Medical  Review. 
this  book  will  become  what  its  author  hoped  it 


18 


BLANCHARD   &   LEA'S   MEDICAL 


JONES  (C.  HANDFIELD),  F.  R.  S.,   &,    EDWARD    H.  SIEVEKING,  M.  D. 
A  MANUAL  OF  PATHOLOGICAL  ANATOMY.     With  numerous  engravings 

ou  wood.    la  oae  handsome  volume.    (Preparing.) 


KIRKES  (WILLIAM   SENHOUSE),    M.  D., 

Demonstrator  of  Morbid  Anatomy  at  St.  Bartholomew's  Hospital,  &c.;  and 

JAMES   PAGET,   F.  R.  S., 

Lecturer  on  General  Anatomy  and  Physiology  in  St.  Bartholomew's  Hospital. 

A    MANUAL    OF    PHYSIOLOGY.     Second  American,  from  the  second  and 


improved  London  edition.    With  one  hundred  and  sixty-five  illustration!*, 
handsome  royal  12mo.  volume,     pp.550.     (Just Issued.) 


In  one  large  and 


In  the  present  edition,  the  Manual  of  Physiology 
has  been  brought  up  to  the  actual  condition  of  the 
science,  and  fully  sustains  the  reputation  which  it 
has  already  so  deservedly  attained.  We  consider 
the  work  of  MM.  Kirkes  and  Paget  to  constitute  one 
of  the  very  best  handbooks  of  Physiology  we  possess 
— presenting  just  such  an  outline  of  the  science,  com- 
prising an  account  of  its  leading  facts  and  generally 
admitted  principles,  as  the  student  requires  during 
his  attendance  upon  a  course  of  lectures,  or  for  re- 
ference whilst  preparing  for  examination.  The  text 
is  fully  and  ably  illustrated  by  a  series  of  very  supe- 
rior wood-engravings,  by  which  a  comprehension  of 
some  of  the  more  intricate  of  the  subjects  treated  of 
is  greatly  facilitated. — Am.  Medical  Journal . 

We  need  only  say,  that,  without  entering  into  dis- 
cussions of  unsettled  questions,  it  contains  all  the 
recent  improvements  in  this  department  of  medical 
science.  For  the  student  beginning  this  study,  and 
the  practitioner  who  has  but  leisure  to  refresh  his 
memory,  this  book  is  invaluable,  as  it  contains  all 


that  it  is  important  to  know,  without  special  details, 
which  are  read  with  interest  only  by  those  vrfvo 
would  make  a  specialty,  or  desire  to  possess  a  criti- 
cal knowledge  of  the  subject. — Charleston  Medical 
Journal . 

One  of  the  best  treatises  that  can  be  put  into  the 
hands  of  the  student. — London  Medical  Gazette. 

The  general  favor  with  which  the  first  edition  of 
this  work  was  received,  and  its  adoption  as  a  favor- 
ite text-book  by  many  of  our  colleges,  will  insure- a 
large  circulation  to  this  improved  edition.  It  will 
fully  meet  the  wants  of  the  student.  —  Southern 
Med.  and  Surg.  Journal. 

Particularly  adapted  to  those  who  desire  to  pos- 
sess a  concise  digest  of  the  facts  of  Human  Physi- 
ology.— British  and  Foreign  Med.-Chirurg.  Review. 

We  conscientiously  recommend  it  as  an  admira- 
ble "  Handbook  of  Physiology." — London  Journal 
of  Medicine. 


KNAPP  (F.),  PH.  D.,  &c. 

TECHNOLOGY ;  or,  Chemistry  applied  to  the  Arts  and  to  Manufactures.  Edited, 
with  numerous  Notes  and  Additions,  by  Dr.  EDMUND  RONALDS  and  Dr.  THOMAS  RICHARDSON. 
First  American  edition,  with  Notes  and  Additions,  by  Prof.  WALTER  R.  JOHNSON.  In  two  hand- 
some octavo  volumes,  printed  and  illustrated  in  the  highest  style  of  art,  with  about  five  hundred 
wood-engravings. 


PHYSIOLOGICAL 

(Preparing.) 


LEHMANN. 
CHEMISTRY.     Translated  by  GEORGE  E.  DAY,  M.  D. 


LEE  (ROBERT),   M.  D.,  F.  R.  S.,  &c. 
CLINICAL    MIDWIFERY;    comprising  the   Histories  of  Five  Hundred  and 

Forty-five  Cases  of  Difficult,  Preternatural,  and  Complicated  Labor,  with  Commentaries.    From 
the  second  London  edition.    In  one  royal  12mo.  volume,  extra  cloth,  of  238  pages. 


LA   ROCHE   (R.),    M.  D.,  &c. 

PNEUMONIA ;  its  Supposed  Connection,  Pathological  and  Etiological,  with  Au- 
tumnal Fever*,  including  an  Inquiry  into  the  Existence  and  Morbid  Agency  of  Malaria.  In  one 
handsome  octavo  volume,  extra  cloth,  of  500  pages. 

A  more  simple,  clear,  and  forcible  exposition  of  i  the  periodical  press,  and  yet  in  the  work  before  us 
the  groundless  nature  and  dangerous  tendency  of!  he  has  exhibited  an  amount  of  industry  Hnd  learning, 
certain  pathological  and  etiological  heresies,  has  j  research  and  ability,  beyond  what  we  are  accustomed 
seldom  been  presented  to  our  notice. — N.  Y.  Journal  j  to  discover  in  modern  medical  writers;  while  his 
of  Medicine  and  Collateral  Science,  March,  1854.  j  own  extensive  opportunities  for  observation  and 

I  experience  have  been  improved  by  the  most  laudable 

This  work  should  be  carefully  studied  by  Southern  diligence,  and  display  a  familiarity  with  the  whole 
physicians,  embodying  as  it  does  the  reflections  of  j  subject  in  every  aspect,  which  commands  both  our 
an  original  thinker  and  close  observer  on  a  subject  |  regpect  and  confidence.  As  a  corrective  of  prevalent 
peculiarly  their  own.—  Virginia  Med.  and  Surgical  j  and  mischievous  error,  sought  to  be  propagated  by 
Journal.  j  novices  and  innovators,  we  could  wish  that  Dr.  ta 

The  author  had  prepared  us  to  expect  a  treatise  i  Roche's  book  could  be  widely  read.— N.  Y.  Medical 
from  him,  by  his  brief  papers  on  kindred  topics  in  !  Gazette. 


LONGET  (F.  A.) 

TREATISE  ON  PHYSIOLOGY.  With  numerous  Illustrations.  Translated 
from  the  French  by  F.  G.  Smith,  M.  D.,  Professor  of  Institutes  of  Medicine  in  the  Pennsylvania 
Medical  College.  (Preparing.) 


AND    SCIENTIFIC   PUBLICATIONS.  19 

LAWRENCE  (W.),  F.  R.  S.,  Sec. 
A  TREATISE    ON    DISEASES    OF    THE    EYE.     A    new  edition,   edited, 

with  numerous  additions,  and  243  illustrations,  by  ISAAC  HAYS,  M.  D.,  Surgeon  to  Wills  Hospi- 
tal, &c.     In  one  very  large  and  handsome  octavo  volume,  of  950  pages*,  strongly  bound  in  leather 
with  raised  bands.     (Now  Ready.) 
This  work  is  thoroughly  revised  and  brought  up  to  1854. 

This  work  is  so  universally  recognized  as  the  standard  authority  on  the  subject,  that  the  pub- 
Kshers  in  presenting  this  new  edition  have  only  to  remark  that  in  its  preparation  the  editor  has 
carefully  revised  every  portion,  introducing  additions  and  illustrations  wherever  the  advance  of 
science  has  rendered  them  necessary  or  desirable.  In  this  manner  it  will  be  found  to  con- 
tain over  one  hundred  pages  more  than  the  last  edition,  while  the  list  of  wood-engravings 
has  been  increased  by  sixty-seven  figures,  besides  numerous  improved  illustrations  substituted 
for  such  as  were  deemed  imperfect  or  unsatisfactory.  The  various  important  contributions  to 
ophthalmological  science,  recently  made  by  Dalrymple,  Jacob,  Walton,  Wilde,  Cooper,  &c., 
both  in  the  form  of  separate  treatises  and  contributions  to  periodicals,  have  been  carefully 
examined  by  the  editor,  and,  combined  with  the  results  of  his  own  experience,  have  been 
freely  introduced  throughout  the  volume,  rendering  it  a  complete  and  thorough  exponent  of 
the  most  advanced  state  of  the  subject.  Among  the  most  important  additions  may  be  mentioned 
a  full  account  of  the  recent  microscopical  investigations  into  the  structure  and  pathology  of  the 
eye ;  the  description  of  several  affections  not  treated  of  in  the  original ;  an  account  of  the 
catoptric  investigation  of  the  eye,  and  of  its  employment  as  a  means  of  diagnosis  ;  a  description 
of  recently  invented  instruments  for  illuminating  the  retina,  and  of  some  new  methods  for  examin- 
ing the  interior  structures  of  the  eye.  Very  great  improvements  will  likewise  be  found  in  the 
typographical  and  mechanical  execution  of  the  work. 

In  a  future  number  we  shall  notice  more  at  length  I  octavo  pages— has  enabled  both  author  and  editor  to 
this  admirable  treatise -the  safest  guide  and  most  do  justice" to  all  the  details  of  this  subject,  and  con- 
comprehensive  work  of  reference,  which  is  within  |  dense  in  this  single  volume  the  present  state  of  our 
the  reach  of  all  classes  of  the  profession.— Stetho-  j  knowledge  of  the  whole  science  in  this  department, 
scwe,  March,  1854.  whereby  its  practical  value  cannot  be  excelled.  We 

!  heartily  commend  it,  especially  as  a  book  of  refe- 

This  standard  text-book  on  the  department  of  ,  rence,  indispensable  in  every  medical  library.  The 
which  it  treats,  has  not  been  superseded,  by  any  or  '  additions  of  the  American  editor  very  greatly  en- 
all  of  the  numerous  publications  on  the  subject  i  hance  the  value  of  the  work,  exhibiting  the  learning 
heretofore  issued.  Nor  with  the  multiplied  improve-  j  and  experience  of  Dr.  Hays,  in  the  light  in  which  he 
ments  of  Dr.  Hays,  the  American  editor,  is  it  at  all  ought  to  be  held,  as  a  standard  authority  on  all  sub- 
likely  that  this  great  work  will  cease  to  merit  the  j  jects  appertaining  to  this  specialty,  to  which  he  has 
confidence  and  preference  of  students  or  practition-  j  rendered  so  many  valuable  contributions. — N.  Y. 
era.  Its  ample  extent — nearly  one  thousand  large  |  Medical  Gazette. 

BY  THE  SAME   AUTHOR. 

A  TREATISE  ON  RUPTURES;  from  the  fifth  London  edition.    In  one  octavo 

volume,  sheep,  480  pages. 

LISTON  (ROBERT),   F.  R.  S.f  &c. 
LECTURES  ON  THE  OPERATIONS  OF  SURGERY,  and  on  Diseases  and 

Accidents  requiring  Operations.  Edited,  with  numerous  Additions  and  Alterations,  by  T.  D. 
MUTTER,  M.  D.  In  one  large  and  handsome  octavo  volume,  of  566  pages,  with  216  wood-cuts. 

LALLEMAND  (M.). 

THE  CAUSES,  SYMPTOMS,  AND  TREATMENT  OF  SPERMATOR- 
RHOEA. Translated  and  edited  by  HENRY  J.  McDouGAL.  In  one  volume,  octavo,  320  pages. 
Second  American  edition.  (Now  Ready.) 

LARDNER  (DIONYSIUS),   D.  C.  L.,  &c. 
HANDBOOKS    OF    NATURAL    PHILOSOPHY    AND    ASTRONOMY. 

Revised,  with  numerous  Additions,  by  the  American  editor.  FIRST  COURSE,  containing  Mecha- 
nics, Hydrostatics,  Hydraulics,  Pneumatics,  Sound,  and  Optics.  In  one  large  royal  12mo. 
volume,  of  750  pages,  with  424  wood-cuts.  SECOND  COURSE,  containing  Heat,  Electricity,  Mag- 
netism, and  Galvanism,  one  volume,  large  royal  12mo.,  of  450  pages,  with  250  illustrations. 
THIRD  COURSE  (  now  ready),  containing  Meteorology  and  Astronomy,  in  one  large  volume,  royal 
12mo.  of  nearly  eight  hundred  pages,  with  thirty-seven  plates  and  two  hundred  wood-outs.  The 
whole  complete  in  three  volumes,  of  about  two  thousand  large  pages,  with  over  one  thousand 
figures  on  steel  and  wood. 

The  various  sciences  treated  in.  this  work  will  be  found  brought  thoroughly  up  to  the  latest 
period. 

The  work  furnishes  a  very  clear  and  satisfactory  ]  factory  manner  the  information  they  desire. — The 
account  of  our  knowledge  in  the  important  depart-  |  Virginia  Med.  and  Surg.  Journal. 
ment  of  science  of  which  it  treats.     Although  the 

medical  schools  of  this  country  do  not  include  the  i  The  present  treatise  is  a  most  complete  digest  of 
study  of  physics  in  their  course  of  instruction,  yet  j  all  that  has  been  developed  in  relation  to  the  great 
no  student  or  practitioner  should  be  ignorant  of  its  j  forces  of  nature,  Heat,  Magnetism,  and  Electricity, 
laws.  Besides  being  of  constant  application  in  prac-  Their  laws  are  elucidated  in  a  manner  both  pleasing 
tice,  such  knowledge  is  of  inestimable  utility  in  fa-  and  familiar,  and  at  the  same  time  perfectly  intelli- 
eilitating  the  study  of  other  branches  of  science.  To!  gible  to  the  student.  The  illustrations  are  suffi- 


students,  then,  and  to  those  who,  having  already  en 


ing  already 
ness,  arede 


tared  upon  the  active  pursuits  of  business,  are  desir- 
ous to  sustain  and  improve  their  knowledge  of  the 
general  truths  of  natural  philosophy,  we  can  recom- 
mend this  work  as  supplying  in  a  clear  and  satis 


ciently  numerous  and  appropriate,  and  altogether 
we  can  cordially  recommend  the  work  as  well-de- 
serving the  notice  both  of  the  practising  physician 
and  the  student  of  medicine.— The  Med.  Examiner. 


20 


BLANCHARD   &   LEA'S   MEDICAL 


MEIGS(CHARLES   D.),  M.  D., 

Professor  of  Obstetrics,  &c.,  in  the  Jefferson  Medical  College,  Philadelphia. 

WOMAN :  HER  DISEASES  AND  THEIR  REMEDIES.  A  Series  of  Lec- 
tures to  his  Class.  Third  and  Improved  edition.  In  one  large  and  beautifully  printed  octavo 
volume.  (Just  Ready.  Revised  and  enlarged  to  1854.) 

The  gratifying-  appreciation  of  his  labors,  as  evinced  by  the  exhaustion  of  two  large  impressions 
of  this  work  within  a  few  years,  has  not  been  lost  upon  the  author,  who  has  endeavored  in  every 
way  to  render  it  worthy  of  the  favor  with  which  it  has  been  received.  The  opportunity  thus 
afforded  for  a  second  revision  has  been  improved,  and  the  work  is  now  presented  as  in  every  way 
superior  to  its  predecessors,  additions  and  alterations  having  been  made  whenever  the  advance  of 
science  has  rendered  them  desirable.  The  typographical  execution  of  the  work  will  also  be  found 
to  have  undergone  a  similar  improvement  and  the  work  is  now  confidently  presented  as  in  every 
way  worthy  the  position  it  has  acquired  as  the  standard  American  text-book  on  the  Diseases  of 
Females. 


It  contains  a  vast  amount  of  practical  knowledge, 

lined 


by  one  who  has  accurately  observed  and  retai 
the  experience  of  many  years,  and  who  tells  the  re- 
sult in  a  free,  familiar,  and  pleasant  manner. — Dub- 
lin Quarterly  Journal. 

There  is  an  off-hand  fervor,  a  glow,  and  a  warm- 
heartedness infecting  the  effort  of  Dr.  Meigs,  which 
is  entirely  captivating,  and  which  absolutely  hur- 
ries the  reader  through  from  beginning  to  end.  Be- 
sides, the  book  teems  with  solid  instruction,  and 
it  shows  the  very  highest  evidence  of  ability,  viz., 
the  clearness  with  which  the  information  is  pre- 
sented. We  know  of  no  better  test  of  one's  under- 
standing a  subject  than  the  evidence  of  the  power 
of  lucidly  explaining  it.  The  most  elementary,  as 
well  as  the  obscurest  subjects,  under  the  pencil  of 
Prof.  Meigs,  are  isolated  and  made  to  stand  out  in 
such  bold  relief,  as  to  produce  distinct  impressions 
upon  the  mind  and  memory  of  the  reader.  —  The 
Charleston  Med.  Journal. 


Professor  Meigs  has  enlarged  and  amended  this 
great  work,  for  such  it  unquestionably  is,  having 
passed  the  ordeal  of  criticism  at  home  and  abroad, 
but  been  improved  thereby  ;  for  in  this  new  edition 
the  author  has  introduced  real  improvements,  and 
increased  the  value  and  utility  of  the  book  im- 
measurably. It  presents  so  many  novel,  bright, 
and  sparkling  thoughts;  such  an  exuberance  of  new 
ideas  on  almost  every  page,  that  we  confess  OUF- 
selves  to  have  become  enamored  with  the  book 
and  its  author;  and  cannot  withhold  our  congratu- 
lations from  our  Philadelphia  confreres,  that  such  a 
teacher  is  in  their  service.  AVe  regret  that  our 
limits  will  not  allow  of  a  more  extended  notice  of 
thit  work,  but  must  content  ourselves  with  thus 
f  commending  it  as  worthy  of  diligent  perusal  by 
physicians  as  well  as  students,  who  are  seeking  to 
be  thoroughly  instructed  in  the  important  practical 
subjects  of  which  it  treats. — N.  Y.  Med.  Gazette. 


BY  THE  SAME   AUTHOR. 

OBSTETRICS :  THE  SCIENCE  AND   THE   ART.     Second  edition,  revised 

and  improved.     With  one  hundred  and  thirty-one  illustrations.     In  one  beautifully  printed  octavo 
volume,  of  seven  hundred  and  fifty-two  large  pages.     (Lately  Published.) 

The  rapid  demand  for  a  second  edition  of  this  work  is  a  sufficient  evidence  that  it  has  supplied 
a  desideratum  of  the  profession,  notwithstanding  the  numerous  treatises  on  the  same  subject  which 
have  appeared  within  the  last  few  years.  Adopting  a  system  of  his  own,  the  author  has  combined 
the  leading  principles  of  his  interesting  and  difficult  subject,  with  a  thorough  exposition  of  its  rules 
of  practice,  presenting  the  results  of  long  and  extensive  experience  and  of  familiar  acquaintance 
with  all  the  modern  writers  on  this  department  of  medicine.  As  an  American  Treatise  on  Mid- 
wifery, which  has  at  once  assumed  the  position  of  a  classic,  it  possesses  peculiar  claims  to  the  at- 
tention and  study  of  the  practitioner  and  student,  while  the  numerous  alterations  and  revisions 
which  it  has  undergone  in  the  present  edition  are  shown  by  the  great  enlargement  of  the  work, 
which  is  not  only  increased  as  to  the  size  of  the  page,  but  also  in  the  number.  Among  other  addi- 
tions may  be  mentioned 

A  NEW  AND  IMPORTANT  CHAPTER  ON  "CHILDBED  FEVER." 


BY   THE   SAME   AUTHOR.      (Now  Ready.) 

A  TREATISE  ON  ACUTE  AND  CHRONIC  DISEASES  OF  THE  NECK 

OF  THE  UTERUS.     With  numerous  plates,  drawn  and  colored  from  nature  in  the  highest 
style  of  art.    In  one  handsome  octavo  volume,  extra  cloth. 

The  object  of  the  author  in  this  work  has  been  to  present  in  a  small  compass  the  practical  results 
of  his  long  experience  in  this  important  and  distressing  class  of  diseases.  The  great  changes  intro- 
duced into  practice,  and  the  accessions  to  our  knowledge  on  the  subject,  within  the  last  few  years, 
resulting  from  the  use  of  the  metroscope,  brings  within  the  ordinary  practice  of  every  physician 
numerous  cases  which  were  formerly  regarded  as  incurable,  and  renders  of  great  value  "a  work  like 
the  present  combining  practical  directions  for  diagnosis  and  treatment  with  an  ample  series  of  illus- 
trations, copied  accurately  from  colored  drawings  made  by  the  author,  after  nature.  No  such  accu- 
rate delineations  of  the  pathology  of  the  neck  of  the  uterus  have  heretofore  been  given,  requiring, 
as  they  do  the  rare  combination  of  physician  and  artist,  and  their  paramount  importance  to  the 
physician  in  whose  practice  such  cases  are  frequent,  is  too  evident  to  be  dwelt  upon,  while  in 
artistic  execution  they  are  far  in  advance  of  anything  of  the  kind  as  yet  produced  in  this  country. 

BY  THE   SAME  AUTHOR. 

OBSERVATIONS   ON    CERTAIN    OF    THE    DISEASES    OF    YOUNG 

CHILDREN.     In  one  handsome  octavo  volume,  of  214  pages. 

' 

BY  THE  SAME  AUTHOR.     (Preparing.) 

ON  THE  NATURE,  SIGNS,  AND  TREATMENT  0$  PUERPERAL 

FEVER.    In  one  handsome  octavo  volume. 


AND   SCIENTIFIC    P  CJBLIC  ATIONS. 


21 


MILLER  (JAMES),   F.  R.  S.  E., 

Professor  of  Surgery  in  the  University  of  Edinburgh,  &c. 

PRINCIPLES  OF  SURGERY.     Third  American,  from  the  second  and  revised 

Edinburgh  edition.  Revised,  with  Addition?,  by  F.  W.  SARGENT,  M.  D.,  author  of  "  Minor  Sur- 
gery," &c.  In  one  large  and  very  beautiful  volume,  of  seven  hundred  and  fifty-two  pages,  with 
two  hundred  and  forty  exquisite  illustrations  on  wood. 

The  publishers  have  endeavored  to  render  the  present  edition  of  this  work,  in  every  point  of  me- 
ehanical  execution,  worthy  of  its  very  high  reputation,  and  they  confidently  present  it  to  the  pro- 
fession as  one  of  the  handsomest  volumes  as  yet  issued  in  this  country. 

This  edition  is  far  superior,  both  in  the  abundance  |  guage.  This  opinion,  deliberately  formed  after  a 
and  quality  of  its  material,  to  any  of  the  preceding,  j  careful  study  of  the  first  edition,  we  have  had  no 
We  hope  it  will  be  extensively  read,  and  the  sound  i  cause  to  change  on  examining  the  second.  This 
principles  which  are  herein  taught  treasured  up  for  edition  has  undergone  thorough  revision  by  the  au- 
appliention.  The  work  takes  rank  with  thor ;  many  expressions  have  been  modified,  and  a 

_r_  r> — it e  ni — :_.  :* — *_:_!„  A~ *     mass  of  new  matter  introduced.     The  book  is  got  up 

in  the  finest  style,  and  is  an  evidence  of  the  progress 
of  typography  in  our  country. — Charleston  Medical 
Journal  and  Review. 


future 

Watson's  Practice  of  Physic ;  it  certainly  does  not 
fall  behind  that  great  \vork  in  soundness  of  princi- 
ple or  depth  of  reasoning  and  research.  No  physi- 
cian who  values  his  reputation,  or  seeks  the  interests 
of  his  clients,  can  acquit  himself  before  his  God  and 
the  world  without  making  himself  familiar  with  the 
sound  and  philosophical  views  developed  in  the  fore- 
going book. — New  Orleans  Medical  and  Surgical 
J 


We  recommend  it  to  both  student  and  practitioner, 
feeling  assured  that  as  it  now  comes  to  us,  it  pre- 
sents the  most  satisfactory  exposition  of  the  modern 
doctrines  of  the  principles  of  surgery  to  be  found  in 
any  volume  in  any  language. — N.  Y.  Journal  of 
Medicine. 


Tovrnal. 

Without  doubt  the  ablest  exposition  of  the  prin- 
ciples of  that  branch  of  the  healing  art  in  any  lan- 

BY  THE  SAME  AUTHOR.    (Now  Ready.) 

THE  PRACTICE  OF   SURGERY.     Third  American  from  the  second  Edin- 

burgh  edition.    Edited,  with  Additions,  by  F.  W.  SARGENT,  M.  D  ,  one  of  the  Surgeons  to  Will's 

Hospital,  &c.    Illustrated  by  three  hundred  and  nineteen  engravings  on  wood.     In  one  larg>e 

octavo  volume,  of  over  seven  hundred  pages. 

This  new  edition  will  be  found  greatly  improved  and  enlarged,  as  well  by  the  addition  of  much 
new  matter  as  by  the  introduction  of  a  large  and  complete  series  of  handsome  illustrations.  An 
equal  improvement  exists  in  the  mechanical  execution  of  the  work,  rendering  it  in  every  respect 
a  companion  volume  to  the  "Principles." 

No  encomium  of  ours  could  add  to  the  popularity  By  the  almost  unanimous  voice  of  the  profession, 
of  Miller's  Surgery.  Its  reputation  in  this  country  his  works,  both  on  the  principles  and  practice  of 
is  unsurpassed  by  that  of  any  other  work,  and,  when  surgery  have  been  assigned  the  highest  rank.  If  we 


taken  in  connection  with  the  author's  Principles  of 
Surgery,  constitutes  a  whole,  without  reference  to 
which  no  conscientious  surgeon  would  be  willing 
to  practice  his  art.  The  additions,  by  Dr.  Sargent, 
have  materially  enhanced  the  value  of  the  work. — 
Southern  Medical  and  Surgical  Journal. 

It  is  seldom  that  two  volumes  have  ever  made  so 
profound  an  impression  in  so  short  a  time  as  the 
"  Principles"  and  the  "  Practice"  of  Surgery  by 
Mr.  Miller — or  so  richly  merited  the  reputation  they 
have  acquired.  The  author  is  an  eminently  sensi- 
ble, practical,  and  well-informed  man,  who  knows 
exactly  what  he  is  talking  about  and  exactly  how  to 
talk  it. — Kentucky  Medical  Recorder. 

The  two  volumes  together  form  a  complete  expose 
of  the  present  state  of  Surgery,  and  they  ought  to  be 
on  the.  shelves  of  every  surgeon. — N.  J.  Med.  Re- 
porter. 


were  limited  to  but  one  work  on  surgery,  that  on« 
should  be  Miller's,  as  we  regard  it  superior  to  all 
others. — St.  Louis  Med.  and  Surg.  Journal. 

The  author  distinguished  alike  as  a  practitioner 
and  writer,  has  in  this  and  his  "  Principles,"  pre- 
sented to  the  profession  one  of  the  most  compl  etc  and 
reliable  systems  of  Surgery  extant.  His  style  of 
writing  is  original,  impressive,  and  engaging,  ener- 
getic, concise,  and  lucid.  Few  have  the  faculty  of 
condensing  so  much  in  small  space,  and  at  the  same 
time  so  persistently  holding  the  attention;  indeed, 
he  appears  to  make  the  very  process  of  condensation 
a  means  of  eliminating  attractions.  Whether  as  a 
text-book  for  students  or  a  book  of  reference  for 
practitioners,  it  cannot  be  too  strongly  recommend- 
ed.— Southern  Journal  of  the  Medical  and  Physical 
Sciences. 


MALGAIGNE  (J.  F.). 

OPERATIVE  SURGERY,  based  on  Normal  and  Pathological  Anatomy.  Trans- 
lated from  the  French,  by  FREDERICK  BRITTAN,  A.  B.,  M.  D.  With  numerous  illustrations  on 
wood.  In  one  handsome  octavo  volume,  of  nearly  six  hundred  pages. 


We  have  long  been  accustomed  to  refer  to  it  as  one 
of  the  most  valuable  text-books  in  our  library. — 
Buffalo  Med.  and  Surg.  Journal. 

Certainly  one  of  the  best  books  published  on  ope- 
rative surgery.— Edinburgh  Medical  Journal. 


To  express  in  a  few  words  our  opinion  of  Mal- 

gaigne's  work,  we  unhesitatingly  pronounce  it  the 

very  best  guide  in  surgical  operations  that  has  come 

before  the  profession  in  any  language. — Charleston 

\  Med.  and  Surg.  Journal. 


MOHR  (FRANCIS),  PH.  D.,  AND  REDWOOD  (TH  EOPHI  LUS). 

PRACTICAL    PHARMACY.     Comprising  the  Arrangements,  Apparatus,  and 
Manipulations  of  the  Pharmaceutical  Shop  and  Laboratory.    Edited,  with  extensive  Additions, 
by  Prof.  WILLIAM  PROCTER,  of  the  Philadelphia  College  of  Pharmacy.     In  one  handsomely 
printed  octavo  volume,  of  570  pages,  with  over  500  engravings  on  wood. 
It  is  a  book,  however,  which  will  be  in  the  hands 
of  almost  everyone  who  is  much  interested  in  phar- 
maceutical operations,  as  we  know  of  no  other  pub- 


lication so  well  calculated  to  fill  a  void  long  felt.— 
Medical  Examiner. 

The  book  is  strictly  practical,  and  describes  only 
manipulations  or  methods  of  performing  the  nume- 
rous processes  the  pharmaceutist  has  to  go  through, 
hi  the  preparation  and  manufacture  of  medicines, 
together  with  all  the  apparatus  and  fixtures  neces- 


sary thereto.  On  these  matters,  this  work  is  very 
full  and  complete,  and  details,  in  a  style  uncom- 
monly clear  and  lucid,  not  only  the  more  compli- 
cated and  difficult  processes,  but  those  not  less  im- 
portant oneg,  the  most  simple  and  common. — Buffalo 
Medical  Journal. 

The  country  practitioner  who  is  obliged  to  dis- 
pense his  own  medicines,  will  find  it  a  most  valuable 
assistant.— Monthly  Journal  and  Retrospect. 


22  BLANCHARD   &   LEA'S   MEDICAL 

MACLISE    (JOSEPH),    SURGEON. 

SURGICAL  ANATOMY.  Forming  one  volume,  very  large  imperial  quarto. 
With  sixty-eight  large  and  splendid  Plates,  drawn  in  the  best  style  and  beautifully  colored.  Con- 
taining one  hundred  and  ninety  Figures,  many  of  them  the  size  of  life.  Together  with  copious 
and  explanatory  letter-press.  Strongly  and  handsomely  bound  in  extra  cloth,  being  one  of  the 
cheapest  and  best  executed  Surgical  works  as  yet  issued  in  this  country. 

Copies  can  be  sent  by  mail,  in  five  parts,  done  up  in  stout  covers. 

This  great  work  being  now  concluded,  the  publishers  confidently  present  it  to  the  attention  of  the 
profession  as  worthy  in  every  respect  of  their  approbation  and  patronage.  No  complete  work  of 
the  kind  has  yet  been  published  in  the  English  language,  and  it  therefore  will  supply  a  want  long 
felt  in  this  country  of  an  accurate  and  comprehensive  Atlas  of  Surgical  Anatomy  to  which  the 
student  and  practitioner  can  at  all  times  refer,  to  ascertain  the  exact  relative  position  of  the  various 
portions  of  the  human  frame  towards  each  other  and  to  the  surface,  as  well  as  their  abnormal  de- 
viations. The  importance  of  such  a  work  to  the  student  in  the  absence  of  anatomical  material,  and 
to  the  practitioner  when  about  attempting  an  operation,  is  evident,  while  the  price  of  the  book,  not- 
withstanding the  large  size,  beauty,  and  finish  of  the  very  numerous  illustrations,  is  so  low  as  to 
place  it  within  the  reach  of  every  member  of  the  profession.  The  publishers  therefore  confidently 
anticipate  a  very  extended  circulation  for  this  magnificent  work. 


One  of  the  greatest  artistic  triumphs  of  the  age 
in  Surgical  Anatomy. — British  American  Medical 
Journal. 

Too  much  cannot  be  said  in  its  praise;  indeed, 
we  have  not  language  to  do  it  justice. — Ohio  Medi- 
cal and  Surgical  Journal. 

The  most  admirable  surgical  atlas  we  have  seen. 


of  keeping  up  his  anatomical  knowledge. — Medieal 
Times. 

The  mechanical  execution  cannot  be  excelled. — 
Transylvania  Medical  Journal. 

A  work  which  has  no  parallel  in  point  of  acen- 
racy  and  cheapness  in  the  English  language. — N.  Y. 
Journal  of  Medicine. 


To  the  practitioner  deprived  of  demonstrative  dis- 

eections  upon  the  human  subject,  it  is  an  invaluable        To  a11  engaged  in  the  study  or  practice  of  their 

companion.— N.  J.  Medical  Reporter.  I  profession,  such  a  work  is  almost  indispensable.— 

„,,  _,•...,,,     I  Dubltn  Quarterly  Medical  Journal. 

The  most  accurately   engraved    and  beautifully 
colored  plates  we  have  ever  seen  in  an  American  I      No  practitioner  whose  means  will  admit  should 


book — one  of  the  best  and  cheapest  surgical  works 


ever  published.— Buffalo  Medical  Journal. 

Country  practitioners  will  find  these  plates  of  im- 


It  is  very  rare  that  so  elegantly  printed,  so  well 
illustrated,  and  so  useful  a  work,  is  offered  at  so 
moderate  a  price.— Charleston  Medical  Journal. 


fail  to  possess  it. — Ranking's  Abstract. 


mense  value.— N.  Y.  Medical  Gazette. 
We  are  extremely  gratified   to  announce  to  the 


!  profession  the  completion  of  this  truly  magnificent 
Its  plates  can  boast  a  superiority  which  places  I  work    which,  as  a  whole,  certainly  stands  unri- 
thern almost  beyond  the  reach  of  competition.— Medi-    vaned,  both  for  accuracy  of  drawing,   beauty  of 
cat  examiner.  coloring,  and  all  the  requisite  explanations  of  the 

Every  practitioner,  we  think,  should  have  a  work  |  subject  in  hand.— The  New   Orleans  Medical  and 


of  this  kind  within  reach.— Southern  Medical  and 


Surgical  Journal. 


This  is  by  far  the  ablest  work  on  Surgical  Ana- 

Wosuch  lithographic  illustrations  of  surgical  re-  tomy  that  has  come  under  our  observation.  We 
gions  have  hitherto,  we  think,  been  given.—  Boston  kno(v  of  no  other  work  that  would  justify  a  stu- 
Medical  and  Surgical  Journal.  \  dent>  in  any  degree5  for  neglect  of  actual  diggec. 

As  a  surgical  anatomist,  Mr.  Maclise  has  proba-  !  tion-     ln  those  sudden  emergencies  that  so  often 

taneous  command 


bly  no  superior.— British  and  Foreign  Medico-Chi- 
rurgical  Review. 


arise>  and  which  requ,ire  thf  instantaneous  command 
of  minute  anatomical  knowledge,  a  work  of  this  kind 
keeps  the  details  of  the  dissecting-room  perpetually 
fresh  in  the  memoi 
cine  and  Surgery. 

The  very  low  price  at  which  this  work  is  furnished,  and  the  beauty  of  its  execution, 
require  an  extended  sale  to  compensate  the  publishers  for  the  heavy  expenses  incurred. 


Of  great  value  to  the  student  engaged  in  dissect-  I  fres'hin  the  memory. — The  Western  Journal  of  Medi- 
ing,  and  to  the  surgeon  at  a  distance  from  the  means  I  cin 


MULLER  (PROFESSOR  J.),  M.D. 
PRINCIPLES  OF  PHYSICS   AND   METEOROLOGY.     Edited,  with  Addi- 

tions,  by  R.  EGLESFELD  GRIFFITH,  M.  D.    In  one  large  and  handsome  octavo  volume,  extra 
doth,  with  550  wood-cuts,  and  two  colored  plates. 

The  Physics  of  Mailer  is  a  work  superb,  complete.  I  tion  to  the  scientific  records  of  this  country  may  be 
unique:  thegreatest  want  known  to  English  Science  (  duly  estimated  by  the  fact  that  the  cost  of  the  origi- 
could  not  have  been  better  supplied.  The  work  is  I  nal  drawings  and  engravings  alone  has  exceeded  the 
of  surpassing  interest.  The  value  of  this  contribu-  |  sum  of  £2,000.— Lancet. 


MAYNE  (JOHN),  M.  D.,  M.  R.  C.  S., 
A  DISPENSATORY  AND  THERAPEUTICAL  REMEMBRANCER.   Com- 

prising  the  entire  lists  of  Materia  Medica,  with  every  Practical  Formula  contained  in  the  three 
British  Pharmacopoeias.  With  relative  Tables  subjoined,  illustrating,  by  upwards  of  six  hundred 
and  sixty  examples,  the  Extemporaneous  Forms  and  Combinations  suitable  for  the  different 
Medicines.  Edited,  with  the  addition  of  the  Formulae  of  the  United  States  Pharmacopoeia,  by 
R.  EGLESFELD  GRIFFITH,  M.  D.  In  one  12mo.  volume,  extra  cloth,  of  over  300  large  pages. 


MATTEUCCI  (CARLO). 
LECTURES  ON  THE  PHYSICAL  PHENOMENA  OF  LIVING  BEINGS. 

Edited  by  J.  PEREIRA,  M.  D.    In  one  neat  royal  12mo.  volume,  extra  cloth,  with  cuts,  388  pages. 


AND  SCIENTIFIC   PUBLICATIONS.  23 

£ , f 

NEILL  (JOHN),  M.  D., 

Surgeon  to  the  Pennsylvania  Hospital,  &c.;  and 
FRANCIS  GURNEY  SMITH,   M.D., 

Professor  of  Institutes  of  Medicine  in  the  Pennsylvania  Medical  College. 

AN  ANALYTICAL   COMPENDIUM   OF   THE   VARIOUS   BRANCHES 

OF  MEDICAL  SCIENCE  ;  for  the  Use  and  Examination  of  Students.  Second  edition,  revised 
and  improved.  In  one  very  large  and  handsomely  printed  royal  12mo.  volume,  of  over  one 
thousand  pages,  with  three  hundred  and  fifty  illustrations  on  wood.  Strongly  bound  in  leather, 
with  raised  bands. 

The  speedy  sale  of  a  large  impression  of  this  work  has  afforded  to  the  authors  gratifying  evidence 
of  the  correctness  of  the  views  which  actuated  them  in  its  preparation.  In  meeting  the  demand 
for  a  second  edition,  they  have  therefore  been  desirous  to  render  it  more  worthy  of  the  favor  with 
which  it  has  been  received.  To  accomplish  this,  they  have  spared  neither  time  nor  labor  in  embo- 
dying in  it  such  discoveries  and  improvements  as  have  been  made  since  its  first  appearance,  and 
such  alterations  as  have  been  suggested  by  its  practical  use  in  the  class  and  examination-room. 
Considerable  modifications  have  thus  been  introduced  throughout  all  the  departments  treated  of  in 
tlie  volume,  but  more  especially  in  the  portion  devoted  to  the  "Practice  of  Medicine,"  which  has 
been  entirely  rearranged  and  rewritten.  The  authors  therefore  again  submit  their  work  to  the 
jwofession,  with  the  hope  that  their  efforts  may  tend,  however  humbly,  to  advance  the  great  cause 
of  medical  education. 

Notwithstanding  the  enlarged  size  and  improved  execution  of  this  work,  the  price  has  not  been 
increased,  and  it  is  confidently  presented  as  one  of  the  cheapest  volumes  now  before  the  profession. 


In  the  rapid  course  of  lectures,  where  work  for 
Ihe  students  is  heavy,  and  review  necessary  for  an 
examination,  a  compend  is  not  only  valuable,  but 
it  is  almost  a  sine  qua  non.  The  one  before  us  is, 
in  most  of  the  divisions,  the  most  unexceptionable 
of  all  books  of  the  kind  that  we  know  of.  The 
newest  and  soundest  doctrines  and  the  latest  im- 
provements and  discoveries  are  explicitly,  though 
concisely,  laid  before  the  student.  Of  course  it  is 
useless  for  us  to  recommend  it  to  all  last  course 
students,  but  there  is  a  class  to  whom  we  very 
sincerely  commend  this  cheap  book  as  worth  its 
weight  in  silver  — that  class  is  the  graduates  in 
medicine  of  more  than  ten  years'  standing,  who 
have  not  studied  medicine  since.  They  will  perhaps 
find  out  from  it  that  the  science  is  not  exactly  now 
what  it  was  when  they  left  it  off. — The  Stethoscope 


Having  made  free  use  of  this  volume  in  our  ex- 
aminations of  pupils,  we  can  speak  from  experi- 
ence in  recommending  it  as  an  admirable  compend 
for  students,  and  as  especially  useful  to  preceptors 
who  examine  their  pupils.  It  will  save  the  teacher 
much  labor  by  enabling  him  readily  to  recall  all  of 
the  points  upon  which  his  pupils  should  be  ex- 
amined. A  work  of  this  sort  should  be  in  the  hand* 
of  every  one  who  takes  pupils  into  his  office  with  a 
view  of  examining  them;  and  this  is  unquestionably 
the  best  of  its  class.  Let  every  practitioner  who  has 
pupils  provide  himself  with  it,  and  he  will  find  the 
labor  of  refreshing  his  knowledge  so  much  facilitated 
that  he  will  be  able  to  do  justice  to  his  pupils  at  very 
little  cost  of  time  or  trouble  to  himself. — Transyl- 
vania Med.  Journal. 


NELIGAN  (J.    MOORE),  M.  D.,  M.  R.  I.  A.,  &c. 
A   PRACTICAL   TREATISE   ON   DISEASES   OF   THE    SKIN.     In  one 

neat  royal  12mo.  volume,  of  334  pages. 

OWEN  (PROF.    R). 
ON  THE   DIFFERENT  FORMS   OF  THE   SKELETON.     One  vol.  royal 

12mo.,  with  numerous  illustrations.    (Preparing.) 

POPULAR    PHYSIOLOGY. 
THE  PHYSIOLOGY  OF  ANIMAL  AND  VEGETABLE  LIFE.    In  one 

neat  royal  12mo.  volume,  of  about  200  pages,  with  100  wood-cuts.     (Just  Ready.) 
The  latest  information  on  physiological  subjects  will  be  found  in  this  work,  popularly  and  clearly 
explained,  rendering  it  suitable  for  schools  and  school  libraries,  as  well  as  for  private  readers. 

PHILLIPS  (BENJAMIN),  F.  R.  S.,  &c. 

SCROFULA;  its  Nature,  its  Prevalence,  its  Causes,  and  the  Principles  of  its 
Treatment.  In  one  volume,  octavo,  with  a  plate. 

PANCOAST  (J.),  M.  D.f 
Professor  of  Anatomy  in  the  Jefferson  Medical  College,  Philadelphia,  &c. 

OPERATIVE  SURGERY;  or,  A  Description  and  Demonstration  of  the  various 
Processes  of  the  Art ;  including  all  the  New  Operations,  and  exhibiting  the  Slate  of  Surgical 
Science  in  its  present  advanced  condition.  Complete  in  one  royal  4to.  volume,  of  380  pages  of 
letter-press  description  and  eighty  large  4to.  plates,  comprising  486  illustrations.  Second  edition, 
improved. 

Blanchard  &  Lea  having  become  the  publishers  of  this  important  book,  have  much  pleasure  in 
offering  it  to  the  profession. 


This  excellent  work  is  constructed  on  the  model 
of  the  French  Surgical  Works  by  Velpeau  and  Mal- 
gaigne;  and,  so  far  as  the  English  language  is  con- 


cerned, we  are  proud  as  an  American  to  say  that, 

01  ITS  KIND  IT  HAS  NO  SUPERIOR.— A'.  Y.  Jovmal  of 

Medicine. 


PARKER  (LANGSTON)., 

Surgeon  to  the  Queen's  Hospital,  Birmingham. 

THE  MODERN  TREATMENT  OF  SYPHILITIC  DISEASES,  BOTH  PRI- 
MARY AND  SECONDARY;  comprising  the  Treatment  of  Constitutional  and  Confirmed  Syphi- 
lis, by  a  safe  and  successful  method.  With  numerous  Cases,  Formulee,  and  Clinical  Observa- 
tions. From  the  Third  and  entirely  rewritten  London  edition.  In  one  neat  octavo  volume. 
(Nearly  Ready .) 

:    \  1( .  8911 


24 


BLANCHARD  &   LEA'S   MEDICAL 


(Now  Complete.) 

PEREIRA  (JONATHAN),  M.  D.,  F.  R.  S.,  AND  L.  S. 
THE    ELEMENTS    OF    MATERIA    MEDICA    AND    THERAPEUTICS. 

Third  American  edition,  enlarged  and  improved  by  the  author;  including  Notices  of  most  of  the 
Medicinal  Substances  in  use  in  the  civilized  world,  and  forming  an  Encyclopaedia  of  Materia 
Medica.  Edited,  with  Additions,  by  JOSEPH  CARSON,  M.  D.,  Professor  of  Materia  Medica  and 
Pharmacy  in  the  University  of  Pennsylvania.  In  two  very  large  octavo  volumes  of  2100  pages, 
on  small  "type,  with  over  four  hundred  and  fifty  illustrations. 
VOLUME  I. — Lately  issued,  containing  the  Inorganic  Materia  Medica,  over  800  pages,  with  145 

illustrations. 

VOLUME  II. — Now  ready,  embraces  the  Organic  Materia  Medica,  and  forms  a  very  large  octavo 
volume  of  1250  pages,  with  two  plates  and  three  hundred  handsome  wood-cuts. 
The  present  edition  of  this  valuable  and  standard  work  will  enhance  m  every  respect  its  well- 
deserved  reputation.  The  care  bestowed  upon  its  revision  by  the  author  may  be  estimated  by  the 
fact  that  its  size  has  been  increased  by  about  five  hundred  pages.  These  additions  have  extended 
to  every  portion  of  the  work,  and  embrace  not  only  the  materials  afforded  by  the  recent  editions  of 
the  pharmacopoeias,  but  also  all  the  important  information  accessible  to  the  care  and  industry  of 
the  author  m  treatises,  essays,  memoirs,  monographs,  and  from  correspondents  in  various  parts  of 
the  globe.  In  this  manner  the  work  comprises  the  most  recent  and  reliable  information  respecting 
all  the  articles  of  the  Materia  Medica,  their  natural  and  commercial  history,  chemical  and  thera- 
peutical properties,  preparation,  uses,  doses,  and  modes  of  administration,  brought  up  to  the  present 
time,  with  a  completeness  not  to  be  met  with  elsewhere.  A  considerable  portion  of  the  work 
which  preceded  the  remainder  in  London,  has  also  enjoyed  the  advantage  of  a  further  revision  by 
the  author  expressly  for  this  country,  and  in  addition  to  this  the  editor,  Professor  Carson,  has  made 
whatever  additions  appeared  desirable  to  adapt  it  thoroughly  to  the  U  S.  Pharmacopoeia,  and  to 
the  wants  of  the  American  profession.  An  equal  improvement  will  likewise  be  observable  in  every 
department  of  its  mechanical  execution.  It  is  printed  from  new  type,  on  good  white  paper,  with  a 
greatly  extended  and  improved  series  of  illustrations. 

Gentlemen  who  have  the  first  volume  are  recommended  to  complete  their  copies  without  delay. 
The  first  volume  will  no  longer  be  sold  separate. 

When  we  remember  that  Philology,  Natural  His-  [  Medica.  although  completed  under  the  supervision  of 
tory,  Botany,  Chemistry,  Physics,  and  the  Micro-  |  others,  is  by  fur  the  most  elaborate  treatise  in  the 
scope,  are  all  brought  forward  to  elucidate  the  sub-  English  language,  and  will1,  While  medical  literature 
ject,  one  cannot  fail  to  see  that  the  reader  has  here  I  is  cherished,  continue  a  monument  alike  honorable 
a  work  worthy  of  the  name  of  an  encyclopedia  of  j  to  his  genius,  as  to  his  learning  and  industry. — 


Materia  Medica.  Our  own  opinion  of  its  merits  is 
that  of  its  editors,  and  also  that  of  the  \yhole  profes- 
sion, both  of  this  and  foreign  countries— namely, 
"  that  in  copiousness  of  details,  in  extent,  variety, 
and  accuracy  of  information,  and  in  lucid  explana- 
tion of  difficult  and  recondite  subjects,  it  surpasses 
all  other  works  on  Materia  Medica  hitherto  pub- 
lished." We  cannot  close  this  notice  without  allud- 
ing to  the  special  additions  of  the  American  editor, 
which  pertain  to  the  prominent  vegetable  produc- 
tions of  this  country,  and  to  the  directions  of  the 


United  States  Pharmacopoeia,  in  connection  with  all 
the  articles  contained  in  the  volume  which  are  re- 
ferred to  by  it.  The  illustrations  have  been  increased, 
and  this  edition  by  Dr.  Carson  cannot  well  be  re- 
garded in  any  other  light  than  that  of  a  treasure 


American  Journal  of  Pharmacy,  March,  1854. 

The  work,  in  its  present  shape,  and  so  far  as  can 
be  judged  from  the  portion  before  the  public,  forms 
the  most  comprehensive  and  complete  treatise  on 
materia  medica  extant  in  the  English  language.— 
Dr.  Pereira  has  been  at  great  pains  to  introduce 
into  his  work,  not  only  all  the  information  on  the 
natural,  chemical,  and  commercial  history  of  medi- 
cines, which  might  be  serviceable  to  the  physician 
and  surgeon,  but  whatever  might  enable  his  read- 


ers to  understand  thoroughly  the  mode  of  prepar- 
ing and  manufacturing  various  articles  employed 
either  for  preparing  medicines,  or  for  certain  pur- 
poses in  the  arts  connected  with  materia  mediea 
and  the  practice  of  medicine.  The  accounts  of  the 

which  should  be  found  in  the  library  of  every  physi-  !  physiological  and  therapeutic  effects  of  remedies  are 
cian.-New  York  Journal  of  Medical  and  Collateral  \  given  with  great  clearness  and  accuracy,  and  m  a 


Science,  March,  1854. 
The  third  edition  of  his  "Elements  of  Materia 


manner  calculated  to  interest  as  well  as  instruct 
the  reader.— The  Edinburgh  Medical  and  Surgical 
Journal. 


PEASELEE  (E.  R.),   M.  D. 

Professor  of  Anatomy  and  Physiology  in  Dartmouth  College,  &c. 

HUMAN  HISTOLOGY,  in  its  applications  to  Physiology  and  General  Pathology, 
designed  as  a  Text-Book  for  Medical  Students.  With  numerous  illustrations.  In  one  handsome 
royal  12mo.  volume.  (Preparing:) 

The  subject  of  this  work  is  one,  the  growing  importance  of  which,  as  the  basis  of  Anatomy  and 
Physiology,  demands  for  it  a  separate  volume.  The  book  will  therefore  supply  an  acknowledged 
deficiency  in  medical  text-books,  while  the  name  of  the  author,  and  his  experience  as  a  teacher  for 
the  last  thirteen  years,  is  a  guarantee  that  it  will  be  thoroughly  adapted  to  the  use  of  the  student. 



PIRRIE  (WILLIAM),  F.  R.  S.  E., 
Professor  of  Surgery  in  the  University  of  Aberdeen. 

THE    PRINCIPLES  AND  PRACTICE  OF  SURGERY.     Edited  by  JOHN 

NEILL,  M.  D.,  Demonstrator  of  Anatomy  in  the  University  of  Pennsylvania,  Surgeon  to  the 
Pennsylvania  Hospital,  &c.  In  one  very  handsome  octavo  volume,  of  780  pages,  with  316  illus- 
trations. (Just  Issued.) 


We  know  of  no  other  surgical  work  of  a  reason- 
able size,  wherein  there  is  so  much  theory  and  prac- 
tice, or  where  subjects  are  more  soundly  or  clearly 
taught. — The  Stethoscope. 

There  is  scarcely  a  disease  of  the  bone  or  goft 
parts,  fracture,  or  dislocation,  that  is  not  illustrated 
by  accurate  wood-engravings.  Then,  again,  every 
instrument  employed  by  the  surgeon  is  thus  repre- 
sented. These  engravings  are  not  only  correct,  but 
really  beautiful,  showing  the  astonishing  degree  of 
perfection  to  which  the  art  of  wood- engraving  baa 


arrived.  Prof.  Pirrie,  in  the  work  before  us,  has 
elaborately  discussed  the  principles  of  surgery,  and 
a  safe  and  effectual  practice  predicated  upon  them. 
Perhaps  no  work  upon  this  subject  heretofore  issued 
is  so  full  upon  the  science  of  the  art  of  surgery. — 
Nashville  Journal  of  Medicine  and  Surgery. 

One  of  the  best  treatises  on  surgery  in  the  English 
language. — Canada  Med.  Journal. 

Our  impression  is,  that,  as  a  manual  for  students, 
Pirrie's  is  the  best  work  extant.— Western  Med.  and 
Surg.  Journal. 


AND    SCIENTIFIC    PUBLICATIONS. 


25 


RAMSBOTHAM  (FRANCIS  H.),  M.D. 
THE  PRINCIPLES  AND  PRACTICE  OF  OBSTETRIC  MEDICINE  AND 

SURGERY,  in  reference  to  the  Process  of  Parturition.     Sixth  American,  from  the  last  London 
edition.     Illustrated  with  one  hundred  and  forty-eight  Figures,  on  fifty-five  Lithographic  Plates. 
In  one  large  and  handsomely  printed  volume,  imperial  octavo,  with  520  pages. 
In  this  edition,  the  plates  have  all  been  redrawn,  and  the  text  carefully  read  and  corrected.     It 
is  therefore  presented  as  in  every  way  worthy  the  favor  with  which  it  has  so  long  been  received. 

From  Prof.  Hodge,  of  the  University  of  Pa. 

To  the  American  public,  it  is  most  valuable,  from  its  intrinsic  undoubted  excellence?  and  as  being 
the  best  authorized  exponent  of  British  Midwifery.  Its  circulation  will,  I  trust,  be  extensive  throughout 
our  country. 

When  the  whole  profession  is  thus  unanimous 
in  placing  such  a  work  in  the  very  first  rank  as 
regards  the  extent  and  correctness  of  all  the  details 


We  recommend  the  student  who  desires  to  mas- 
ter this  difficult  subject  with  the  least  possible 
trouble,  to  possess  himself  at  once  of  a  copy  of  this 
work. — American  Journal  of  the  Med.  Sciences. 

It  stands  at  the  head  of  the  long  list  of  excellent 
obstetric  works  published  in  the  last  few  years  in 
Great  Britain,  Ireland,  and  the  Continent  of  Eu- 
rope. We  consider  this  book  indispensable  to  the 
library  of  every  physician  engaged  in  the  practice 
of  midwifery.— Southern  Med.  and  Surg.  Journal. 


of  the  theory  and  practice  of  so  important  a  branch 
of  learning,  our  commendation  or  condemnation 
would  be  of  little  consequence;  but  regarding  it 
as  the  most  useful  of  all  works  of  the  kind,  we 
think  it  but  an  act  of  justice  to  urge  its  claims 
upon  the  profession. — N.  O.  Med.  Journal. 


RICORD  (P.),   M.  D., 
Surgeon  to  the  Hopital  du  Midi,  Paris,  &c. 

ILLUSTRATIONS  OF  SYPHILITIC  DISEASE.   Translated  from  the  French, 

by  THOMAS  F.  BETTON,  M.  D.  "With  the  addition  of  a  History  of  Syphilis,  and  a  complete  Bib- 
liography and  Formulary  of  Remedies,  collated  and  arranged,  by  PAUL  B.  GODDAHD,  M.  D.  "With 
fifty  large  quarto  plates,  comprising  one  hundred  and  seventeen  beautifully  colored  illustrations. 
In  one  large  and  handsome  quarto  volume. 

Blanchard  &  Lea  having  purchased  the  remainder  of  this  valuable  work,  which  was  originally 
soid  as  a  subscription  book,  are  now  prepared  to  offer  it  to  the  profession.  It  is  universally  known 
as  one  of  the  handsomest  volumes  as  yet  presented  in  this  country,  and  as  containing  the  only  ex- 
tended and  thorough  series  of  illustrations  on  the  subject. 

BY   THE  SAME  AUTHOR.      (Now  Ready.} 

A  TREATISE  ON  THE  VENEREAL  DISEASE.     By  JOHN  HUNTER,  F.  R.  S. 

With  copious  Additions,  by  PH.  RICORD,  M.  D.  Edited,  with  Notes,  by  FREEMAN  J.  BUMSTEAD, 
M.  D.  In  one  handsome  octavo  volume,  with  plates. 

From  the  Translator's  Preface. 

"  M.  Ricord's  annotations  to  Hunter's  Treatise  on  the  Venereal  Disease  were  first  published  at 
Paris,  in  1840,  in  connection  with  Dr.  G.  Richelot's  translation  of  the  work,  including  the  contri- 
butions of  Sir  Everard  Home  and  Mr.  Babington.  In  a  second  edition,  which  has  recently  ap- 
peared, M.  Ricord  has  thoroughly  revised  his  part  of  the  work,  bringing  it  up  to  the  knowledge  of 
the  present  day,  and  so  materially  increasing  it  that  it  now  constitutes  full  one-third  of  the  volume. 

"  This  publication  has  been  received  with  great  favor  by  the  French,  both  because  it  has  placed 
within  their  reach  an  important  work  of  Hunter,  and  also  because  it  is  the  only  recent  practical 
work  which  M.  Ricord  has  published,  no  edition  of  his  Traite  des  Maladies  Vcntriennes  having 
appeared  for  the  last  fifteen  years." 


In  the  notes  to  Hunter,  the  master  substitutes  him- 
self for  his  interpreters,  and  give?  his  original  thoughts 
to  the  world,  in  a  summary  form  it  is  true,  but  in  a 
lucid  and  perfectly  intelligible  manner.  In  conclu- 
sion \ve  can  say  that  this  is  incontestably  the  best 
treatise  on  syphilis  with  which  we  are  acquainted, 
and,  as  we  do  not  often  employ  the  phrase,  we  may 
be  excused  for  expressing  the  hope  that  it  may  find 
a  place  in  the  library  of  every  physician — Virginia 
Med.  and  Surg  Journal. 


Every  one  will  recognize  the  attractiveness  and 
value  which  this  work  derives  from  thus  presenting 
the  opinions  of  these  two  masters  side  by  side.  But, 
it  must  be  admitted,  what  has  made  the  fortune  of 
the  book,  is  the  fact  that  it  contains  the  ''most  com- 
plete embodiment  of  the  veritable  doctrines  of  the 
Hopital  du  Midi,"  which  hns  ever  been  made  public. 
The  doctrinal  ideas  of  M.  Ricord,  ideas  which,  if  not 
universally  adopted,  are  inconlestably  dominant,  have 
heretofore  only  been  interpreted  by  moreor  lessskilful 
secretaries,  sometimes  accredited  and  sometimes  not. 

BY   THE   SAME   AUTHOR. 

LETTERS  ON  SYPHILIS,  addressed  to  the  Chief  Editor  of  the  Union  Medicale. 

With  an  Introduction,  by  Amedee  Latour.     Translated  by  \V.  P.  Lattimore,  M.  D.     In  one  neat 
octavo  volume. 

Blanchard  &  Lea  are  now  the  publishers  of  this  valuable  work. 

From  the  Translator's  Preface. 

To  those  who  have  listened  to  the  able  and  interesting  lectures  of  our  author  at  the  Hopital  du 
Midi,  this  volume  will  need  no  commendation;  while  to  those  who  have  not  had  the  pleasure  to 
which  we  allude,  the  book  will  commend  itself  by  the  truths  it  contains,  told  as  they  are  in  the 
game  inimitable  style  in  which  M.  Ricord  delivers  his  clinical  lectures. 

BY  THE  SAME   AUTHOR. 

A  PRACTICAL  TREATISE  ON  VENEREAL  DISEASES.     With  a  Then* 

peutical  Summary  and  Special  Formulary.    Translated  by  SIDNEY  UOANE,  M.  D.   Fourth  edition. 
One  volume,  octavo,  340  pages. 

- 


26 


BLANCHARD   &   LEA'S   MEDICAL 


HT 


.;     _    ,_..._^i         RIGBY  (EDWARD),   M.  D., 

Physician  to  the  General  Lying-in  Hospital,  &c. 

A   SYSTEM   OF   MIDWIFERY.     With   Notes  and   Additional  Illustrations. 

Second  American  Edition.     One  volume  octavo,  422  pages. 


ROYLE  (J.  FORBES),  M.  D. 
MATERIA  MEDIC  A  AND  THERAPEUTICS;  including  the  Preparations  of 

the  Pharmacopoeias  of  London,  Edinburgh,  Dublin,  and  of  the  United  States.  With  many  new 
medicines.  Edited  by  JOSEPH  CARSON,  M.  D.,  Professor  of  Materia  Medica  and  Pharmacy  in 
the  University  of  Pennsylvania.  With  ninety-eight  illustrations.  In  one  large  octavo  volume, 
of  about  seven  hundred  pages. 

ductions  on  the  other  extreme,  which  are  ne»es 


This  work  is,  indeed,  a  most  valuable  one,  and 
will  fill  up  an  important  vacancy  that  existed  be- 
tween Dr.  Pereira's  most  learned  and  complete 
system  of  Materia  Medica,  and  the  class  of  pro- 


sarily  imperfect  from  their  small   extent.— British 
and  Foreign  Medical  Review. 


SKEY  (FREDERICK  C.),  F.  R.  S.,  &c. 
OPERATIVE  SURGERY.     In  one  very  handsome  octavo  volume  of  over  650 

pages,  with  about  one  hundred  wood-cuts. 


Its  literary  execution  is  superior  to  most  surgical 
treatises.  It  abounds  in  excellent  moral  hints,  and 
is  replete  with  original  surgical  expedients  and  sug- 
geetions. — Buffalo  Med.  and  Surg.  Journal. 

With  high  talents,  extensive  practice,  and  a  long 
experience,  Mr.  Skey  is  perhaps  competent  to  the 
task  of  writing  a  complete  work  on  operative  sur- 
gery.— Charleston  Med.  Journal. 


We  cannot  withhold  from  this  work  our  high  com- 
rrendition.  Students  and  practitioners  will  find  it  an 
invaluable  teacher  and  guide  upon  every  topic  con- 
nected with  this  department. — N.  Y.  Medical  Ga- 
zette. 

A  work  of  the  very  highest  importance — a  work 
by  itself. — London  Med.  Gazette. 


SHARPEY  (WILLIAM),   M.  D.,    JONES   QUAIN,   M.  D.,  AND 
RICHARD  QUAIN,    F.  R.  S.,  &c. 

HUMAN  ANATOMY.     Revised,  with  Notes  and  Additions,  by  JOSEPH  LEIDY, 

M.  D.     Complete  in  two  large  octavo  volumes,  of  about  thirteen  hundred  pages.    Beautifully 
illustrated  with  over  five  hundred  engravings  on  wood. 

It  is  indeed  a  work  calculated  to  make  an  era  in 
anatomical  study,  by  placing  before  the  student 
every  department  of  his  science,  with  a  view  to 
the  relative  importance  of  each ;  and  so  skilfully 
have  the  different  parts  been  interwoven,  that  no 
one  who  makes  this  work  the  basis  of  his  studies, 
will  hereafter  have  any  excuse  for  neglecting  or 
undervaluing  any  important  particulars  connected 
with  the  structure  of  the  human  frame;  and 

whether  the  bias  of  his  mind  lead  him  in  a  more        The  most  complete  Treatise  on  Anatomy  in  the 
especial  manner  to  surgery,  physic,  or  physiology,     English  language.— Edinburgh  Medical  Journal. 
he  will  find  here  a  work  at  once  so  comprehensive  I 

and  practical  as  to  defend  him  from  exclusiveness  \      There  is  no  work  in  the  English  language  to  be 
on   the  one  hand,  and    pedantry  on    the  other. —    preferred  to  Dr.  Quain's  Elements  of  Anatomy. — 
Monthly  Journal  and  Retrospect  of  the  Medical    London  Journal  of  Medicine . 
Sciences. 


We  have  no  hesitation  in  recommending  this  trea- 
tise on  anatomy  as  the  most  complete  on  that  sub- 
ject in  the  English  language;  and  the  only  one, 
perhaps,  in  any  language,  which  brings  the.  state 
of  knowledge  forward  to  the  most  recent  dis€O- 
veries. — The  Edinburgh  Med.  and  Surg.  Journal. 

Admirably  calculated  to  fulfil  the  object  for  which 
it  is  intended. — Provincial  Medical  Journal. 


SMITH  (HENRY    H.),  M.  D.,  AND   HORNER  (WILLIAM  E.),  M.  D. 
AN  ANATOMICAL  ATLAS,  illustrative  of  the  Structure  of  the  Human  Body. 

In.  one  volume,  large  imperial  octavo,  with  about  six  hundred  and  fifty  beautiful  figures. 

late  the  student  upon  the  completion  of  this  Atlas, 
as  it  is  the  most  convenient  work  of  the  kind  that 
has  yet  appeared  ;  and  we  must  add,  the  very  beau- 
tiful manner  in  which  it  is  "got  up''  is  so  creditable 
to  the  country  as  to  be  flattering  to  our  national 
pride. — American  Medical  Journal. 


These  figures  are  well  selected,  and  present  a 
complete  and  accurate  representation  of  that  won- 
derful fabric,  the  human  body.  The  plan  of  this 
Atlas,  which  renders  it  so  peculiarly  convenient 
for  the  student,  and  its  superb  artistical  execution, 
have  been  already  pointed  out.  We  must  congratu- 


SARGENT  (F.  W.),  M.  D. 
ON  BANDAGING  AND  OTHER  POINTS  OF  MINOR  SURGERY.    In 

one  handsome  royal  12mo.  volume  of  nearly  400  pages,  with  128  wood-cuts. 

The  very  best  manual  of  Minor  Surgery  we  have  |      We  have  carefully  examined  this  work,  and  find  it 
seen;  an  American  volume,  with  nearly  four  hundred    well  executed  and  admirably  adapted  to  the  use  of 


pages  of  good  practical  lessons,  illustrated  by  about 
one  hundred  and  thirty  wood-cuts.  In  these  days 
of  "  trial,"  when  a  doctor's  reputation  hangs  upon 
a  clove  hitch,  or  the  roll  of  a  bandage,  it  would  be 
well,  perhaps,  to  carry  such  a  volume  as  Mr.  Sar- 
gent's always  in  our  coat-pocket,  or,  at  all  events, 
to  listen  attentively  to  his  instructions  at  home. — 
Buffalo  Med.  Journal. 


the  student.  Besides  the  subjects  usually  embraeed 
in  works  on  Minor  Surgery,  there  is  a  short  chapter 
on  bathing,  another  oh  anaesthetic  agents,  and  an 
appendix  of  formulae.  The  author  has  given  an  ex- 
cellent work  on  this  subject,  and  his  publishers  hare 
illustrated  and  printed  it  in  most  beautiful  style- — 
The  Charleston  Medical  Journal. 


A  TREATISE  ON 

extra  cloth,  286  pages. 


STANLEY  (EDWARD). 
DISEASES  OF  THE  BONES. 


In  one  volume,  octavo, 


AND    SCIENTIFIC   PUBLICATIONS.  27 

STILLE  (ALFRED),  M.  D. 
PRINCIPLES  OF  THERAPEUTICS.     In  one  handsome  volume.  (Preparing.) 

SIMON  (JOHN),  F.  R.  S. 
GENERAL    PATHOLOGY,    as  conducive  to  the   Establishment  of  Rational 

Principles  for  the  Prevention  and  Cure  of  Disease.  A  Course  of  Lectures  delivered  at  St. 
Thomas's  Hospital  during  the  summer  Session  of  1850.  In  one  neat  octavo  volume.  (Lately 
Issued.} 


SMITH  (TYLER  W.),  M.  D., 

Lecturer  on  Obstetrics  in  the  Hunterian  School  of  Medicine. 

ON   PARTURITION,    AND   THE    PRINCIPLES    AND   PRACTICE    OF 

OBSTETRICS.    In  one  large  duodecimo  volume,  of  400  pages. 


SIBSON   (FRANCIS),    M.D. 

Physician  to  St.  Mary's  Hospital. 


MEDICAL  ANATOMY.     Illustrating  the  Form,  Structure,  and  Position  of  the 

Internal  Organs  in  Health  and  Disease.     In  large  imperial  quarto,  with  splendid  colored  plates. 
To  match  "Maclise's  Surgical  Anatomy."     (Preparing.) 

SOLLY  (SAMUEL),   F.  R.  S. 
THE    HUMAN    BRAIN;    its  Structure,  Physiology,  and  Diseases.     With  a 

Description  of  the  Typical  Forms  of  the  Brain  in  the  Animal  Kingdom.    From  the  Second  and 
much  enlarged  London  edition.     In  one  octavo  volume,  with  120  wood-cuts. 

SCHOEDLER  (FRIEDRICH),   PH.D., 

Professor  of  the  Natural  Sciences  at  Worms,  &c. 

THE  BOOK  OF  NATURE;  an  Elementary  Introduction  to  the  Sciences  of 
Physics,  Astronomy,  Chemistry,  Mineralogy,  Geology,  Botany,  Zoology,  and  Physiology.  First 
American  edition,  with  a  Glossary  and  other  Additions  and  Improvements;  from  the  second 
English  edition.  Translated  from  the  sixth  German  edition,  by  HENRY  MEDLOCK,  F.  C.  S.,  &c. 
In  one  thick  volume,  small  octavo,  of  about  seven  hundred  pages,  with  679  illustrations  on  wood. 
Suitable  for  the  higher  Schools  and  private  students.  (Now  Ready.) 


This  volume,  as  its  title  shows,  covers  nearly  all 
the  sciences,  and  embodies  a  vast  amount  of  informa- 
tion for  instruction.  No  other  work  that  we  have 


seen  presents  the  reader  with  so  wide  a  range  of  ele- 
mentary knowledge,  with  so  full  illustrations,  at  »o 
cheap  a  rate. — Silliman's  Journal,  Nov.  1853. 


TAYLOR  (ALFRED  S.),  M.  D.,  F.  R.  S., 

Lecturer  on  Medical  Jurisprudence  and  Chemistry  in  Guy's  Hospital. 

MEDICAL  JURISPRUDENCE.     Third  American,  from  the  fourth  and  improved 

English  Edition.    With  Notes  and  References  to  American  Decisions,  by  EDWARD  HARTSHORNE, 
M.  D.    In  one  large  octavo  volume,  of  about  seven  hundred  pages.     (Just  Issued.) 

reference,  that  would  be  more  likely  to  afford  the  aid 


We  know  of  no  work  on  Medical  Jurisprudence 
which  contains  in  the  same  space  anything  like  the 
same  amount  of  valuable  matter  .—N.  Y.  Journal  of 
Medicine. 

The  American  editor  has  appended  several  ini- 


desired.  We  therefore  recommend  it  as  the  best  and 
safest  manual  for  daily  use.— American  Journal  of 
Medical  Sciences. 

We  have  heretofore  had  reason  to  refer  to  it  in 


portant  facts,  the  whole  constituting  by  far  the  best,     terma  of  commendation,  and  need  now  only  state 
most  reliable,  and  interesting  treatise  on  Medical  i  that)  in  the  edition  before  us,  the  author  has  corn- 


Jurisprudence,  and  one  that  we  cannot  too  strongly 
recommend  to  all  who  desire  to  become  acquainted 
with  the  true  and  correct  exposition  of  this  depart- 
ment of  medical  literature.-— Northern  Lancet. 
No  work  upon  the  subject  can  be  put  into  the 


pletely  revised  the  whole  work,  making  many  addi- 
tions and  alterations,  and  brought  it  fully  up  to  the 
present  state  of  knowledge.  The  task  of  the  Ameri- 
can editor  has  been  to  present  all  the  important 
facts  and  cases  that  have  recently  occurred  in  our 


hands  of  students  either  of  law  or  medicine  which  ;  own  country,  bearing  on  the  subjects  treated  of. 
will  engage  them  more  closely  or  profitably;  and  No  better  work  can  be  placed  in  the  hands  of  th« 
none  could  be  offered  to  the  busy  practitioner  of  j  phy sician  or  jurist.— St.  Louis  Medical  and  Surgical 
either  culling,  for  the  purpose  of  casual  or  hasty  j  Journal. 

BY   THE   SAME   AUTHOR. 

ON  POISONS,  IN  RELATION  TO  MEDICAL  JURISPRUDENCE  AND 

MEDICINE.    Edited,  with  Notes  and  Additions,  by  R.  E.  GRIFFITH,  M.  D.    In  one  large  octavo 
volume,  of  688  pages. 


The  most  elaborate  work  on  the  subject  that  pur 
literature  possesses. — British  and  Foreign  Medico- 
C-hirurgical  Review. 

It  contains  a  vast  body  of  facta,  which  embrace 
all  that  is  important  in  toxicology,  all  that  is 
necessary  to  the  guidance  of  the  medical  jurist,  and 
all  that  can  be  desired  by  the  lawyer.  —  Medico- 
Chirurgical  Review. 


One  of  the  most  practical  and  trustworthy  workg 
on  Poisons  in  our  language.— Western  Journal  oj 
Medicine. 

It  is,  so  far  as  our  knowledge  extends,  incompa- 
rably the  best  upon  the  subject;  in  the  highest  de- 
gree creditable  to  the  author,  entirely  trustworthy, 
and  indispensable  to  the  student  and  practitioner. — 
N.  Y.  Annalist 


THOMSON  (A.  T.),  M.  D.,  F.  R.  S.,  &c. 

DOMESTIC  MANAGEMENT  OF  THE  SICK  ROOM,  necessary  in  aid  of 
Medical  Treatment  for  the  Cure  of  Diseases.  Edited  by  R.  E.  GRIFFITH,  M.  D.  la  one  large 
royal  12mo.  volume,  with  wood-cuts,  360  pages. 


aril  vd  bsnvj vi 


28 


BLANCHARD   &   LEA'S    MEDICAL 


TOMES  (JOHN),    F.  R.  S. 
A  MANUAL  OF  DENTAL  PRACTICE.     Illustrated  by  numerous  engravings 

on  wood.     In  one  handsome  volume.     (Preparing.) 

TODD  (R.  B.),   M.  D.,  AND  BOWMAN  (WILLIAM),  F.  R.  S. 
PHYSIOLOGICAL    ANATOMY   AND    PHYSIOLOGY   OF   MAN.     With 

numerous  handsome  wood-cuts.    Parts  I,  II,  and  III,  in  one  octavo  volume,  552  pages.     Part  IV 

will  complete  the  work. 

The  distinguishing  peculiarity  of  this  work  is,  that  the  authors  investigate  for  themselves  every 
fact  asserted ;  and  it  is  the  immense  labor  consequent  upon  the  vast  number  of  observations  re- 
quisite to  carry  out  this  plan,  which  has  so  long  delayed  the  appearance  of  its  completion.  The 
first  portion  oi  Part  IV,  with  numerous  original  illustrations,  was  published  in  the  Medical  News 
and  Library  for  1853,  and  the  completion  will  be  issued  immediately  on  its  appearance  in  London. 
Those  who  have  subscribed  since  the  appearance  of  the  preceding  portion  of  the  work  can  have 
tte  three  parts  by  mail,  on  remittance  of  $2  50  to  the  publishers. 

TRANSACTIONS  OF   THE   AMERICAN    MEDICAL   ASSOCIATION. 
VOLUME  VI,  for  1853,  large  8vo.,  of  870  pages,  with  numerous  colored  plates 

and  wood-cuts. 
Also  to  be  had,  a  few  sets  of  the  Transactions  from  1848  to  1853,  in  six  large  octavo  volumes, 

price  $25.     These  volumes  are  published  by  and  sold  on  account  of  the  Association. 

WATSON   (THOMAS),    M.  D.,    &c. 
LECTURES    ON    THE   PRINCIPLES    AND    PRACTICE    OF   PHYSIC. 

Third  American,  from  the  last  London  edition.    Revised,  with  Additions,  by  D.  FRANCIS  CONDIE, 
M.  D  ,  author  of  a  "  Treatise  on  the  Diseases  of  Children,"  &c.     In  one  octavo  volume,  of  nearly 
eleven  hundred  large  pages,  strongly  bound  with  raised  bands. 
To  say  that  it  is  the  very  best  work  on  the  sub-  |      Confessedly  one  of  the  very  best  works  on  the 


ject  now  extant,  is  but  to  echo  the  sentiment  of  the 
medical  press  throughout  the  country.  —  N.  O. 
Medical  Journal. 

Of  the  text-books  recently  republished  Watson  is 
very  justly  the  principal  favorite. — Holmes's  Rep. 
to  Nat.  Med.  Assoc. 

By  universal  consent  the  work  ranks  among  the 
very  best  text-books  in  our  language. — Illinois  and 
Indiana  Med.  Journal. 

Regarded  on  all  hands  as  one  of  the  very  best,  if 
not  the  very  best,  systematic  treatise  on  practical 
medicine  extant.— St.  Louis  Med.  Journal. 


principles  and  practice  of  physic  in  the  English  or 
any  other  language. — Med.  Examiner. 

Asa  text-book  it  has  no  equal ;  as  a  compendium 
of  pathology  and  practice  no  superior.— New  York 
Annalist. 

We  know  of  no  work  better  calculated  for  being 
placed  in  the  hands  of  the  student,  and  for  a  text- 
book; on  every  important  point  the  author  seems 
to  have  posted  up  his  knowledge  to  the  day. — 
Amer.  Med.  Journal. 

One  of  the  most  practically  useful  books  that 
ever  was  presented  to  the  student.  —  N.  Y.  Med. 
Journal. 


WALSHE   (W.    H.),    M.  D., 

Professor  of  the  Principles  and  Practice  of  Medicine  in  University  College,  London. 

DISEASES    OF    THE    HEART,    LUNGS,    AND    APPENDAGES;    their 

Symptoms  and  Treatment.     In  one  handsome  volume,  large  royal  12mo.,  512  pages. 
We  consider  this  as  the  ablest  work  in  the  En-  I  the  author  being  the  first  stethoscopist  of  the  day.— 
gltsli  language,  on  the  subject  of  which  it  treats  j  |  Charleston  Medical  Journal. 

WHAT   TO  OBSERVE 
AT    THE    BEDSIDE    AND    AFTER   DEATH,    IN    MEDICAL   CASES. 

Published  under  the  authority  of  the  London  Society  for  Medical  Observation.     In  one  very 
handsome  volume,  royal  12mo  ,  extra  cloth      (Just  Issued.) 


We  hail  the  appearance  of  this  book  as  the  grand 
deaideratum.—CAariesion  Medical  Journal. 

This  is  truly  a  very  capital  book.  The  whole 
medical  world  will  reap  advantages  from  its  publi- 
cation. The  medical  journals  will  soon  show  its 
influence  on  the  character  of  the  ;'  Reports  of  Cases" 
which  they  publish.  Dre.  Ballard  and  Walshe  have 


given  to  the  world,  through  a  small  but  useful 
medical  organization,  a  cheap  but  invaluable  book. 
We  do  advise  every  reader  of  this  notice  to  buy  it 
and  use  it.  Unless  he  is  so  vain  as  to  imagine  him- 
self superior  to  the  ordinary  human  capacity,  he  will 
in  six  months  see  its  inestimable  advantages. — 
Stethoscope. 


WILDE  (W.    R.), 
Surgeon  to  St.  Mark's  Ophthalmic  and  Aural  Hospital,  Dublin. 

AURAL  SURGERY,  AND  THE  NATURE  AND  TREATMENT  OF  DIS- 
EASES OF  THE  EAR.    In  one  handsome  octavo  volume,  with  illustrations.    (Now  Ready.) 

and  treatment  of 


So  little  is  generally  known  in  this  country  concerning  the  causes,  symptoms, 
aural  affections,  that  a  practical  and  scientific  work  on  that  subject,  from  a  practitioner  of  Mr. 
Wilde's  great  experience,  cannot  fail  to  be  productive  of  much  benefit,  by  attracting  attention 
to  this  obscure  class  of  diseases,  which  too  frequently  escape  attention  until  past  relief.  The  im- 
mense number  of  cases  which  have  come  under  Mr.  Wilde's  observation  for  many  years,  have 
afforded  him  opportunities  rarely  enjoyed  for  investigating  this  branch  of  medical  science,  and  his 
work  may  therefore  be  regarded  as  of  the  highest  authority. 

This  work  certainly  contains  more  information  on 
the  subject  to  which  it  is  devoted  than  any  other 
with  which  we  are  acquainted.  We  feel  grateful  to 
the  author  fcfr  his  manful  effort  to  rescue  this  depart- 
ment of  surgery  from  the  hands  of  the  empirics  who 
nearly  monopolize  it.  We  think  he  has  successfully 
shown  that  aural  diseases  are  not  beyond  the  re- 
sources of  art  j  that  they  are  governed  by  the  same 


laws,  and  amenable  to  the  same  general  methods  of 
treatment  as  other  morbid  processes.  The  work  \t, 
not  written  to  supply  the  cravings  of  popular  patro- 
nage, but  it  is  wholly  addressed  to  the  profession, 
and  bears  on  every  page  the  impress  of  the  reflections 
of  a  sagacious  and  practical  surgeon. —  Va.  Surg.  and 
Med.  Journal. 


AND   SCIENTIFIC   PUBLICATIONS. 


29 


WILSON    (ERASMUS),  M.D.,    F.  R.  S., 

Lecturer  on  Anatomy,  London. 

A  SYSTEM  OF  HUMAN  ANATOMY,  General  and  Special.  Fourth  Ameri- 
can, from  the  last  English  edition.  Edited  by  PAUL  B.  GODDARD,  A.  M.,  M  D.  With  two  hun- 
dred and  fifty  illustrations.  Beautifully  printed,  in  one  large  octavo  volume,  of  nearly  six  hun- 
dred pages. 


In  many,  if  not  all  the  Colleges  of  the  Union,  it 
has  become  a  standard  text-book.  This,  of  itself, 
is  sufficiently  expressive  of  its  value.  A  work  very 
desirable  to  the  student;  one,  the  possession  of 
which  will  greatly  facilitate  his  progress  in  the 
study  of  Practical  anatomy. — New  York  Journal  of 
Medicine. 

Its  author  ranks  with  the  highest  on  Anatomy. — 
Soutiu-rn  Medical  and  Surgical  Journal. 


It  offers  to  the  student  all  the  assistance  that  can 

be  expected  from  such  a  work. — Medical  Examiner. 

The  most  complete  and  convenient  manual  for  the 

student  we  possess. — American  Journal  of  Medical 

Science. 

In  every  respect,  this  work  as  an  anatomical 
guide  for  the  student  and  practitioner,  merits  pur 
I  warmest  and  most  decided  praise. — London  Medical 
I  Gazette. 


BY   THE   SAME   AUTHOR. 

THE  DISSECTOR;  or,  Practical  and  Surgical  Anatomy.  Modified  and  Re- 
arranged,  by  PAUL  BECK  GODDARD,  M.  D.  A  new  edition,  with  Revisions  and  Additions.  In 
one  large  and  handsome  volume,  royal  12mo.,  with  one  hundred  and  fifteen  illustrations. 

In  passing  this  work  again  through  the  press,  the  editor  has  made  such  additions  and  improve- 
ments as  the  advance  of  anatomical  knowledge  has  rendered  necessary  to  maintain  the  work  in  the 
high  reputation  which  it  has  acquired  in  the  schools  of  the  United  States,  as  a  complete  and  faithful 
guide  to  the  student  of  practical  anatomy.  A  number  of  new  illustrations  have  been  added,  espe- 
cially in  the  portion  relating  to  the  complicated  anatomy  of  Hernia.  In  mechanical  execution  the 
work  will  be  found  superior  to  former  editions. 

BY   THE   SAME    AUTHOR. 

ON  DISEASES  OF  THE  SKIN.  Third  American,  from  the  third  London 
edition.  In  one  neat  octavo  volume,  of  about  five  hundred  pages,  extra  cloth.  (Just  Issued.) 
Also,  to  be  had  done  up  with  fifteen  beautiful  steel  plates,  of  which  eight  are  exquisitely  colored  ; 
representing  the  Normal  and  Pathological  Anatomy  of  the  Skin,  together  with  accurately  colored 
delineations  of  more  than  sixty  varieties  of  disease,  most  of  them  the  size  of  nature.  The  Plates 
are  also  for  sale  separate,  done  up  in  boards. 

The  increased  size  of  this  edition  is  sufficient  evidence  that  the  author  has  not  been  content 
with  a  mere  republication,  but  has  endeavored  to  maintain  the  high  character  of  his  work  as  the 
standard  text-book  on  this  interesting  and  difficult  class  of  diseases.  He  has  thus  introduced  such 
new  matter  as  the  experience  of  the  last  three  or  four  years  has  suggested,  and  has  made  such 
alterations  as  the  progress  of  scientific  investigation  has  rendered  expedient.  The  illustrations  have 
aiso  been  materially  augmented,  the  number  of  plates  being  increased  from  eight  to  sixteen. 


The  "Diseases  of  the  Skin,"  by  Mr.  Erasmus 
Wilson,  may  now  be  regarded  as  the  standard  work 
in  that  department  of  medical  literature.  The 
plates  by  which  this  edition  is  accompanied  leave 
nothing  to  be  desired,  so  far  as  excellence  of  delinea- 
tion and  perfect  accuracy  of  illustration  are  con- 
cerned*— Medico-Cfiirurgical  Review. 


Of  these  plates  it  is  impossible  to  speak  too  highly . 
The  representations  of  the  various  forms  of  cuta- 
neous disease  are  singularly  accurate,  and  the  color- 
ing exceeds  almost  anything  we  have  met  with  in 
point  of  delicacy  and  finish. — British,  and  Foreign 
Medical  Review. 


BY   THE   SAME   AUTHOR. 


ON    CONSTITUTIONAL    AND    HEREDITARY    SYPHILIS,   AND    ON 

SYPHILITIC  ERUPTIONS.     In  one  small  octavo  volume,  beautifully  printed,  with  four  exqui- 
site colored  plates,  presenting  more  than  thirty  varieties  of  syphilitic  eruptions. 


Dr.  Wilson's  views  on  the  general  subject  of 
Syphilis  appear  to  us  in  the  main  sound  and  judi- 
cious, and  we  commend  the  book  as  an  excellent 
monograph  on  the  subject.  Dr.  Wilson  has  pre- 
sented us  a  very  faithful  and  lucid  description  of 
Syphilis  and  has  cleared  up  many  obscure  points  in 


connection  with  its  transmissibility,  pathology  and 
sequelae.  His  facts  and  references  will,  we  are  satis- 
fied, be  received  as  decisive,  in  regard  to  many 
questiones  vexatne.  They  appear  to  us  entitled  to 
notice  at  some  length. — Medical  Examiner. 


BY   THE   SAME   AUTHOR. 


A  TREATISE  ON  THE   MANAGEMENT  OF   THE    SKIN   AND    HAIR 

IN  RELATION  TO  HEALTH.    Second  American,  from  the  fourth  London  edition.    One  neat 
volume,  royal  12mo. 


WHITEHEAD  (JAMES),    F.  R.  C.  S.,    &c. 
THE  CAUSES  AND  TREATMENT  OF  ABORTION   AND   STERILITY; 

being  the  Result  of  an  Extended  Practical  Inquiry  into  the  Physiological  and  Morbid  Conditions 
of  the  Uterus.     Second  American  Edition.    In  one  volume,  octavo,  368  pages.     (Now  Ready.) 

this  department  of  our  profession,  that  the  practi- 
tioner who  does  not  consult  the  recent  works  on  the 
complaints  of  females,  will  soon  find  himself  in  the 
rear  of  his  more  studious  brethren.  This  is  one  of 
the  works  which  must  be  studied  by  those  who 
would  know  what  the  present  state  of  our  knowledge 
is  respecting  the  causes  and  treatment  of  abortion 
and  sterility. — The  Western  Journal  of  Medicine  and 


The  simple  title  of  this  work  gives  a  very  imper- 
fect idea  of  its  contents.  The  subject  of  sterility 
occupies  a  mere  fraction  of  space,  and  upwards  of 
ode-naif  of  the  whole  volume  is  taken  up  with  an 
elaborate  account  of  menstruation  as  a  physiological 
process,  and  of  the  disorders  which  its  deviations 
from  health  are  apt  to  produce.  —  Medical  Chirurg. 
Review. 


Such  are  the  advances  made  from  year  to  year  in 


Surgery. 


30 


BLANCHARD    &    LEA'S    MEDICAL 


WEST   (CHARLES),    M.  D., 

Physician  to  the  Hospital  for  Sick  Children,  &c. 

LECTURES    ON   THE    DISEASES    OF  INFANCY  AND   CHILDHOOD. 

Second  American,  from  the  second  and  enlarged  London  edition.  (Now  Ready.)  In  one  volume, 
octavo,  of  nearly  five  hundred  pages. 

From  the  Preface  to  the  Second  Edition. 

In  the  preparation  of  the  second  edition  of  these  Lectures,  the  whole  work  has  been  carefully 
revised.  A  few  formulae  have  been  introduced  and  a  minute  alphabetical  index  has  been  appended 
while  additions  amounting  altogether  to  fifty  pages,  have  been  made,  wherever  I  felt  that  more 
extended  observation,  or  more  careful  reflection  had  enabled  me  to  supply  some  of  those  deficiencies 
which  I  am  well  aware,  are  still  far  too  numerous.  The  work  now  contains  the  result  of  640 
observations,  and  199  post-mortem  examinations,  chiefly  made  among  16,276  children  who  came 
under  my  notice  during  the  ten  years  of  my  connection  with  the  Children's  Infirmary  in  Lambeth. 


We  take  leave  of  Dr.  West  with  great  respect  for 
his  attainments,  n  due  appreciation  of  his  acute 
powers  of  observation,  and  a  deep  sense  of  obliga- 
tion for  this  valuable  contribution  to  our  profes- 
sional literature.  His  book  is  undoubtedly  in  many 
respects  the  best  we  possess  on  diseases  of  children. 
The  extracts  we  have  given  will,  we  hope,  satisfy 
our  readers  of  its  value;  and  yet  in  all  candor  we 
must  say  that  they  are  even  inferior  to  some  other 
parts,  the  length  of  which  prohibited  our  entering 
upon  them.  That  the  book  will  shortly  be  in  the 
hands  of  most  of  our  readers  we  do  not  doubt,  and  it 
will  give  us  much  pleasure  if  our  strong  recommend- 
ation of  it  may  contribute  towards  the  result. — The 
Dublin  Quarterly  Journal  of  Medical  Science. 

Dr.  West  has  placed  the  profession  under  deep  ob- 
ligation by  this  able,  thorough,  and  finished  work 


upon  a  subject  which  almost  daily  taxes  to  the  ut- 
most the  skill  of  the  general  practitioner.  He  has 
with  singular  felicity  threaded  his  way  through  all 
the  tortuous  labyrinths  of  the  difficult  subject  he  has 
undertaken  to  elucidate,  and  has  in  many  of  the 
darkest  corners  left  a  light,  for  the  benefit  of  suc- 
ceeding travellers,  which  will  never  be  extinguished. 
Not  the  least  captivating  feature  in  this  admirable 
performance  is  its  easy,  conversational  style,  which 
acquires  force  from  its  very  simplicity,  and  leaves 
an  impression  upon  the  memory,  of  the  truths  it 
conveys,  as  clear  and  refreshing  as  its  own  purity. 
The  author's  position  secured  him  extraordinary  fa- 
cilities for  the  investigation  of  children's  diseases, 
and  his  powers  of  observation  and  discrimination 
have  enabled  him  to  make  the  most  of  these  great 
advantages. — Nashvillt  Medical  Journal. 


WILLIAMS  (C.  J.  B.),    M.  D.,    F.  R.  S.3 

Professor  of  Clinical  Medicine  in  University  College,  London,  fee. 

PRINCIPLES  OF  MEDICINE;  comprising  General  Pathology  and  Therapeu- 
tics, and  a  brief  general  view  of  Etiology,  Nosology,  Semeiology,  Diagnosis,  Prognosis,  and 
Hygienics.  Edited,  with  Additions,  by  MEREDITH  CJLYMER,  M.  D.  Fourth  American,  from  the 
last  and  enlarged  London  edition.  In  one  octavo  volume,  of  476  pages.  (Now  Ready.) 

This  new  edition  has  been  materially  enlarged  and  brought  up  by  the  editor. 

It  possesses  the  strongest  claims  to  the  attention  of  the  medical  student  and  practitioner,  from 
the  admirable  manner  in  which  the  various  inquiries  in  the  different  branches  of  pathology  are 
investigated,  combined,  and  generalized  by  an  experienced  practical  physician,  and  directly  applied 
to  the  investigation  and  treatment  of  disease. — EDITOR'S  PREFACE. 

Few  books  have  proved  more  useful,  or  met  with 


The  best  exposition  in  our  language,  or,  we  be- 
lieve,  in  any  language,  of  rational  medicine,  in  its 
present  improved  and  rapidly  improving  state. — 
British  and  Foreign  Medico-Chirurg.  Review. 


a  more  ready  sale  than  this,  and  no  practitioner 
should  regard  his  library  as  complete  without  it. 
— Ohio  Med.  and  Surg.  Journal. 


BY   THE  SAME  AUTHOR. 

A  PRACTICAL  TREATISE  ON   DISEASES   OF  THE   RESPIRATORY 

OR.GANS;  including  Diseases  of  the  Larynx,  Trachea,  Lungs,  and  Pleurae.    With  numerous 
Additions  and  Notes,  by  M.  CLYMER,  M.  D.    With  wood-cuts.    In  one  octavo  volume,  pp.  508. 


YOUATT  (WILLIAM),  V.  S. 

THE  HORSE.  A  new  edition,  with  numerous  illustrations;  together  with  a 
general  history  of  the  Horse;  a  Dissertation  on  the  American  Trotting  Horse;  how  Trained  and 
Jockeyed;  an  Account  of  his  Remarkable  Performances;  and  an  Essay  on  the  Ass  and  the  Mule. 
By  J.  S.  SKINNER,  formerly  Assistant  Postmaster-General,  and  Editor  of  the  Turf  Register. 
One  large  octavo  volume. 

BY   THE   SAME   AUTHOR. 

THE    DOGr.     Edited  by  E.  J.  LEWIS,  M.  D.     With  numerous  and  beautiful 

illustrations.     In  one  very  handsome  volume,  crown  8vo.,  crimson  cloth,  gilt. 


ILLUSTRATED  MEDICAL  CATALOGUE, 

BLANCHARD  &  LEA  are  preparing  a  Catalogue  of  their  Medical,  Surgical,  and  Scien- 
tific Publications,  containing  descriptions  of  the  works,  with  Notices  of  the  Press,  and 
specimens  of  the  Illustrations,  making  a  pamphlet  of  sixty-four  large  octavo  pages.  It  will 
be  prepared  with  great  care,  and  without  regard  to  expense,  forming  one  of  the  most  beau- 
tiful specimens  of  typographical  execution  as  yet  issued  in  this  country.  Copies  will  be 
sent  by  mail,  and  the  postage  paid,  on  application  to  the  Publishers,  by  inclosing  two  three 
cent  postage  stamps. 


AND   SCIENTIFIC    PUBLICATIONS. 


31 


B.  &  L.  subjoin  a  condensed  list  of  their  publications  in  general  and  educational 
literature,  of  which  more  detailed  catalogues  will  be  furnished  on  application. 

HISTORY  AND  BIOGRAPHY. 

BROWNING'S     HISTORY   OF    THE     HUGUE      LOUIS  BLANC'S  FRENCH  REVOLUTION.  1  v»l. 


NOTS,  1  vol.  8vo. 

CAMPBELL'S  (LORD)  LIVES  OF  THE  LORD 
CHANCELLORS  OF  ENGLAND,  from  the  earl- 
iest Times  to  the  Reign  of  George  IV.  In  seven 
handsome  crown  octavo  volumes,  extra  cloth  or 
half  morocco. 

CAMPBELL'S  (LORD)  LIVES  OF  THE  CHIEF 
JUSTICES  OF  ENGLAND,  from  the  Norman 
Conquest.  In  two  handsome  crown  octavo  vols., 
to  match  the  '•  Chancellors." 

WXON'S  LIFE  OF  WILLIAM  PENN.  A  new 
work.  1  vol.  royal  12mo.,  extra  cloth. 

GRAHAME'S  COLONIAL  HISTORY  OF  THE 
UNITED  STAPES  2  vols.  Svo.  A  new  edition. 

GUIZOT'S  LIFE  OF  CROMWELL.  Two  large 
vols.,  royal  l'2mo.  (Now  ready.) 

HERVEY'S  MEMOIRS  OF  GEORGE  II.  2  vols. 
royal  I2mo.,  extra  doth. 

HUGHES'S  OUTLINES  OF  SCRIPTURE  GEO 
GRAPH Y  AND  HISTORY,  I  vol.,  royal  12mo., 
with  colored  maps.  (Just  issued.) 

IWGERSOLL'S  HISTORY  OF  THE  LATE  WAR. 
2  vols.  8vo. 

KENNEDY'S  LIFE  OF  WILLIAM  WIRT.  2d 
edition,  2  vols.  royal  L2mo.,  extra  cloth,  with  Por- 
trait. 

S«me  work,  library  edition.  2  vols.  8vo. 

KAVANAGH  S  WOMAN  IN  FRANCE  IN  THE 
EIGHTEENTH  CENTURY.  1  vol.  royal  12mo., 
extra  cloth 

LOUIS  BLANC'S  FRANCE  UNDER  LOUIS  PHI 
LJPPE,  1830-1840.  2  vols.  crown  8vo.,  extra  cloth. 


crown  Svo  .  extra  cloth. 
MARSH  (MRS.)  ROMANTIC  HISTORY  OF  THE 

HUGUENOTS.    2  vols.  royal  12mo.,  extra  cloth. 
NIEBUHRS  ANCIEN T  HISTORY.  By  LEONHABD 

SCHMITZ.    In  three  handsome  crovvn  octavo  vols., 

(Lately  Issued.) 
PARDOE'S  FRANCIS  THE  FIRST.    2  vols.  royal 

12mo..  extra  cloth. 
PALGRAVES   NORMANDY  AND    ENGLAND. 

In  three  vols  crown  8vo..  (Preparing.) 
RUSH'S  COURT  OF  LONDON.    1  vol.  Svo. 
RANKE'S  HISTORY  OF    J  HE   REFORMATION 

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